Prevalence of atrial fibrillation among patients with rheumatic valvular heart disease in Ethiopia: A systematic review and meta-analysis

Atrial fibrillation is a common complication of rheumatic valvular heart disease that increases the risk of cardioembolic events and contributes to mortality. In Ethiopia, there is a paucity of studies on the subject, with inconsistent findings between studies. Therefore, this study aimed to estimate the prevalence of atrial fibrillation and identify associated factors among patients with rheumatic valvular heart disease in Ethiopia. Searches were performed in PubMed, Cochrane Library, Google Scholar, HINARI, African Journals Online (AJOL), Europe PMC, and institutional repositories. Data were extracted using an Excel sheet and analysed using STATA version 19. Heterogeneity between studies was assessed using the I² statistic and Cochran's Q test. A qualitative summary of the included studies was performed, and effect sizes were pooled using a random-effects model to estimate the pooled prevalence with a corresponding 95% confidence interval. Ten studies involving 2,332 participants were included in this meta-analysis. The prevalence of atrial fibrillation among patients with rheumatic valvular heart disease was 31.86% (95% CI: 17.48–46.23), with substantial heterogeneity (I² = 98.72%). A higher prevalence was noted among older patients. In addition, mitral stenosis was found to be a statistically significant factor associated with atrial fibrillation (OR = 5.34; 95% CI: 1.88–8.79). Clinicians should actively monitor patients with rheumatic valvular heart disease, especially those with mitral stenosis, for atrial fibrillation to facilitate timely management and reduce the risk of complications. This systematic review and meta-analysis was registered in PROSPERO (CRD420251054974).