Key result
In a South African registry of 302 patients with atrial fibrillation, 63.9% were managed with a rate control strategy and 75.2% received warfarin for stroke prevention.
Cross-Sectional (n=302)
Yes
This South African registry highlights that while AF management generally aligns with global practices, there is a lack of rigour in applying strict rate control criteria and under-utilisation of antithrombotic therapy in eligible patients.
Suggests possible gaps in strict rate control and anticoagulation eligibility in South African AF; leaves open need for prospective regional outcome studies.
BACKGROUND: The burden of cardiovascular disease is expected to escalate in developing countries. However, studies and guidelines concerning atrial fibrillation (AF) are restricted to the developed world. OBJECTIVES: To assess the treatment modalities of AF in South Africa. METHODS: A cross-sectional, observational, multicentre, national registry of the treatment of 302 patients with AF was conducted from February 2010 to March 2011. Specific drug use for rate or rhythm control, as well as drug use for stroke prevention, was surveyed. Events during the 12 months prior to the survey were also characterised, including non-drug treatments, resource utilisation and complications. RESULTS: The single most prevalent clinical characteristic was hypertension (65.9%). Rhythm control was being pursued in 109 patients (36.1%) with class Ic and class III antiarrhythmic agents, while rate control, mainly with beta-blockers, was pursued in the remainder of the patients. Concomitant use of other cardiovascular drugs was high, and 75.2% of patients were on warfarin for stroke prevention. There was a high burden of AF-related morbidity during the preceding year, with 32.5% reporting a history of heart failure, 8.3% a stroke and 5.3% a transient ischaemic attack. Therapeutic success, as defined by either the presence of sinus rhythm or rate-controlled AF, was achieved in 86.8% as judged clinically by the treating physician, but in only 70.2% according to the electrocardiogram criterion of heart rate ≤80 bpm. CONCLUSION: There were no striking differences from previously reported registries worldwide. The lack of application of strict rate control criteria is highlighted.
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Jardine et al. (2014) conducted a cross-sectional in Atrial fibrillation (n=302). Atrial fibrillation treatment modalities was evaluated on Prevalence of AF treatment modalities and use of treatments to prevent thromboembolism. In a South African registry of 302 patients with atrial fibrillation, 63.9% were managed with a rate control strategy and 75.2% received warfarin for stroke prevention.
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