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.
Cohort (n=172)
Yes
Patients with atrial fibrillation in Cameroon experience high rates of mortality and stroke, likely exacerbated by severe comorbidities and significant underutilization of oral anticoagulation.
Underuse of anticoagulation may drive high mortality in Cameroonian AF; leaves open whether closing gaps improves outcomes.
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.
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Ntep-Gweth et al. (2010) conducted a cohort in Atrial fibrillation (n=172). Atrial fibrillation was evaluated on Death. 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.
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