Atrial Fibrillation in Heart Failure: Epidemiology, Quality of Life and Clinical Characteristics in the Iron Deficiency and ANaemia in Heart Failure (IDAN-HF) Study in Ogbomoso, Nigeria

Adeseye A. Akintunde; Olawale Mathias Akinlade

doi:10.4314/ejhs.v33i2.9

April 6, 2023Ethiopian Journal of Health SciencesOpen Access

Atrial Fibrillation in Heart Failure: Epidemiology, Quality of Life and Clinical Characteristics in the Iron Deficiency and ANaemia in Heart Failure (IDAN-HF) Study in Ogbomoso, Nigeria

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Why the study?

The epidemiology of atrial fibrillation and its impact on clinical outcomes and quality of life among heart failure patients in Africa have not been fully described.

Does the presence of atrial fibrillation worsen functional status and clinical characteristics in Nigerian patients with heart failure?

Structured PICO

Does the presence of atrial fibrillation worsen functional status and clinical characteristics in Nigerian patients with heart failure?

P

Population

140 chronic heart failure subjects (followed up for at least 6 months, ≥18 years of age) in Ogbomoso, southwest Nigeria. Mean age 63.0 ± 16.3 years, 57.1% female. Excluded: pregnant, other chronic diseases (malignancy, chronic kidney disease requiring dialysis, major psychiatric illnesses), or acute decompensated HF in the previous two weeks.

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Comparator

Heart failure patients with normal sinus rhythm

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Outcome

Epidemiology (frequency) of atrial fibrillation among heart failure subjects, and its impact on quality of life (Kansas City cardiomyopathy score) and functional status (six minutes walk test distance)

Limitations

Long-term ECG (Holter) was not done, which most likely underestimated the burden of AF
Cross-sectional design prevents evaluating prognostic associations and longitudinal differences in outcomes
Relatively small sample size
Hospital-based study limits generalizability to the general population

Implication

Atrial fibrillation is present in 20% of Nigerian heart failure patients and is associated with significantly worse functional capacity, more comorbidities, and higher rates of pulmonary hypertension and intracardiac clots.

Abstract

Background: The cluster of atrial fibrillation (AF) with heart failure (HF) may be associated with a poorer prognosis. Its epidemiology and impact on clinical outcomes and quality of life among HF subjects in Africa have not yet been fully described. This study aimed at describing the epidemiology of AF among HF subjects, its impact on quality of life, clinical characteristics, and associations. Methods: 140 HF subjects were recruited by stratified random sampling method, and 12-lead electrocardiography was done to diagnose AF. Statistical analysis was done with SPSS 21.0. Informed consent was obtained from all participants. Results: The frequency occurrence of AF was 28 (20.0%) of the HF subjects and were similar in age, systolic blood pressure, diastolic blood pressure, right ventricular internal dimension, packed cell volume, and gender distribution with those in sinus rhythm. The mean (S.D) six minutes walk test distance was significantly lower among HF subjects with AF compared to those without AF (171.1± 88.9 vs. 225.8 ± 102.1m respectively, p <0.05). Pulmonary hypertension, intracardiac clots, and kidney dysfunction were more frequent among HF subjects with AF than among those without AF. HF subjects with AF had a higher frequency of clusters of comorbidities than those without AF. AF was most prevalent and left atrial dimension was highest among subjects who had HF with reduced ejection fraction, compared to other HF phenotypes. Conclusion: AF is common in HF among Nigerians and is associated with poor quality of life and poorer functional status compared to those with sinus rhythm.