What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=172). Intervention: Atrial fibrillation. Primary outcome: Death.

February 23, 2010Open Access

Atrial fibrillation in Africa: clinical characteristics, prognosis, and adherence to guidelines in Cameroon

Key Result

Among patients with atrial fibrillation in Cameroon, oral anticoagulation was prescribed in only 34.2% of eligible patients, and 29.5% of followed patients died over a mean of 318 days.

Study Design

Type

Cohort (n=172)

Multicenter

Yes

Structured PICO

Population

172 patients >18 years old with atrial fibrillation in Cameroon, followed for a mean of 318 days to assess clinical characteristics and guideline adherence.

Outcome

Clinical characteristics, prognosis (death, stroke, severe congestive heart failure), and adherence to guidelines at 318 +/- 124 days follow-uphard clinical

Patients with atrial fibrillation in Cameroon experience high rates of mortality and stroke, likely exacerbated by severe comorbidities and significant underutilization of oral anticoagulation.

Abstract

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.