Key result
24-hour Holter monitoring detects more AF than 12-lead ECG in heart failure and stroke inpatients.
Why the study?
Data on AF in Uganda and elsewhere in sub-Saharan Africa are lacking despite a high prevalence of AF risk factors, comorbidities, and sequelae, motivating an evaluation of AF prevalence among inpatients with acute heart failure or acute ischemic stroke.
Does 24-hour Holter monitoring detect a high prevalence of atrial fibrillation among inpatients admitted with acute heart failure or acute ischemic stroke in southwestern Uganda?
Cohort (n=250)
No
Does 24-hour Holter monitoring detect a high prevalence of atrial fibrillation among inpatients admitted with acute heart failure or acute ischemic stroke in southwestern Uganda?
Using 24-hour Holter monitoring, this study reveals a 42.0% prevalence of atrial fibrillation among high-risk Ugandan inpatients with acute heart failure or ischemic stroke—demonstrating that single 12-lead ECGs miss 60% of cases and highlighting critical gaps in AF detection and anticoagulation access in sub-Saharan Africa.
High atrial fibrillation prevalence on Holter in Ugandan inpatients; extends prior Western data but leaves optimal screening open.
Background: Atrial fibrillation (AF) affects over 37 million people worldwide, and its prevalence is projected to increase by 60% by 2050. Addressing AF is critical in Uganda and elsewhere in sub‑Saharan Africa, where data are lacking despite the high prevalence of AF risk factors, comorbidities, and sequelae. Objectives: To evaluate AF prevalence among inpatients with acute heart failure or acute ischemic stroke in Uganda. Methods: Between November 4, 2024 and November 30, 2025, we recruited a cohort of inpatients at the Regional Referral Hospital in Mbarara, Uganda with either acute heart failure or acute ischemic stroke. We collected baseline clinical data and hospital outcomes, performed a transthoracic echocardiogram, and equipped participants with a 24‑hour Holter monitor. A multivariable logistic regression model was fitted for a primary outcome of AF detection. Results: Among 250 individuals, mean age was 61.7 years (SD 20.5), of whom 175 (70.0%) were women. 123 (49.2%) had acute heart failure; 127 (50.8%) had acute ischemic stroke. Holter monitors detected AF in 105 (42.0%), with a mean AF duration of 11.0 hours (IQR 1.0–21.9) with a bimodal distribution. Mean stroke risk (CHA2DS2VA) was 3.5 (SD 1.6). Factors associated with AF included increasing age in years (OR 1.04, 95% CI 1.02–1.06) and left atrial volume index (mL/m2) (OR 1.02, 95% CI 1.01–1.03). Conclusions: We found high rates of AF among inpatients with acute heart failure or acute ischemic stroke, comparable to studies from the United States and Europe. These findings highlight the need to address AF in Uganda, with improved screening using long‑term monitors, updated treatment protocols, and broadened access to cardiac care.
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Olds et al. (2026) conducted a cohort in Acute heart failure or acute ischemic stroke (n=250). 24-hour Holter monitoring and clinical/echocardiographic risk factors (age per year) vs. Standard 12-lead ECG screening was evaluated on Detection of atrial fibrillation on 24-hour Holter monitoring (OR 1.04, 95% CI 1.02-1.06, p=<0.001). 24-hour Holter monitoring detected atrial fibrillation in 42.0% of Ugandan inpatients with heart failure or ischemic stroke compared to 16.8% by 12-lead ECG, with age associated with AF (OR 1.04).
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