Document Detail


Atrial fibrillation in Africa: clinical characteristics, prognosis, and adherence to guidelines in Cameroon.
MedLine Citation:
PMID:  20179174     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The purpose of this prospective study was to characterize the clinical profile of patients with atrial fibrillation (AF) in the urban population of a sub-Saharan African country and to assess how successfully current guidelines are applied in that context. METHODS AND RESULTS: This prospective study involved 10 cardiologists in Cameroon. Enrolment started on 1 June 2006 and ended on 30 June 2007. Consecutive patients were included if they were >18 years and AF was documented on an ECG during the index office visit. In this survey, 172 patients were enrolled (75 males and 97 females; mean age 65.8 +/- 13 years). The prevalence of paroxysmal, persistent, and permanent AF was 22.7, 21.5, and 55.8%, respectively. Underlying cardiac disorders, present in 156/172 patients (90.7%), included hypertensive heart disease (47.7%), valvular heart disease (25.6%), dilated cardiomyopathy (15.7%), and coronary artery disease (6%). A rate-control strategy was chosen in 83.7% of patients (144 of 172) and drugs most commonly used were digoxin and amiodarone. The mean CHADS(2) score was 1.9 +/- 1.1 and 158 of 172 patients (91.9%) had a CHADS(2) score > or =1. Among patients with an indication for oral anticoagulation (OAC), only 34.2% (54 of 158) actually received it. During a follow-up of 318 +/- 124 days, 26 of 88 patients died (29.5%), essentially from a cardiovascular cause (15 of 26). Ten patients (16.1%) had a non-lethal embolic stroke and 23 (26.1%) had symptoms of severe congestive heart failure. CONCLUSION: Clinical presentation of AF in Cameroon is much more severe than in developed countries. A rate-control strategy is predominant in Cameroon and OAC is prescribed in only 34.2% of eligible patients, despite a high CHADS(2) score at inclusion. Death and stroke rate at 1 year are very high in Cameroon possibly because of a lower use of OAC, and a higher prevalence of rheumatic mitral disease and of more severe co-morbidities.
Authors:
Marie Ntep-Gweth; Marc Zimmermann; Alexandre Meiltz; Samuel Kingue; Pierre Ndobo; Philip Urban; Antoine Bloch
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-02-23
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  12     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-26     Completed Date:  2010-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  482-7     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Hopital De La Tour, 1, Avenue J.-D. Maillard, Meyrin, Geneva 1217, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anticoagulants / therapeutic use
Atrial Fibrillation / drug therapy*,  epidemiology*
Cameroon / epidemiology
Cardiology / standards*,  statistics & numerical data
Comorbidity
Female
Follow-Up Studies
Guideline Adherence*
Health Care Surveys
Heart Diseases / drug therapy*,  epidemiology*
Humans
Male
Middle Aged
Practice Guidelines as Topic
Prospective Studies
Risk Factors
Severity of Illness Index
Urban Population / statistics & numerical data
Chemical
Reg. No./Substance:
0/Anticoagulants

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