Atrial fibrillation in Africa: clinical characteristics, prognosis, and adherence to guidelines in Cameroon

Abstract

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.

Variations in Cause and Management of Atrial Fibrillation in a Prospective Registry of 15 400 Emergency Department Patients in 46 Countries

“…2,7,31,32 Over the past 15 years, many important clinical studies have improved our ability to prevent the morbidity and mortality of AF. 10,12,[14][15][16]33 The benefits of this research have been realized largely by individuals in high-income countries, for whom the research was targeted.…”

Epidemiologic Aspects of Atrial Fibrillation in a Tertiary Hospital in a Sub-Saharan Africa Setting

“…However, most of the patients had a concomitant structural heart disease that can cause AF. AF appears highly symptomatic, with dyspnea and palpitation being the most frequent symptoms [13]. About half of the patients presented with permanent AF.…”

“…This is due to constraints such as the high cost of the new oral anti-coagulants, and the biological surveillance with the anti-vitamin K. Electrical cardioversion was not used in any of the patients. The strategy to control heart rate with digoxin was mostly used in low-income settings as most patients were in heart failure [13] [16] [17]. Betablockers were not frequently used for treating heart failure and controlling heart rate in our setting.…”

La fibrillation atriale, fr&#233quence, facteurs &#233tiologiques, &#233volution et traitement dans un service de cardiologie de Dakar, S&#233n&#233gal

“…L'âge moyen étant de 75 ans [1,6], nettement supérieur à celui retrouvée dans notre série. En Afrique subsaharienne, les données existantes concernent des séries hospitalières avec une prévalence de l'ordre de 7% avec une population relativement jeune [3,4] comme le rapportent certaines séries asiatiques [7,8]. Bien que ne reflétant pas la prévalence exacte de la FA dans la population générale, ces données hospitalières donnent au moins un aperçu sur la réalité de ce trouble du rythme cardiaque chez le Noir qui serait décrit comme étant moins exposé au risque de FA [1].…”

“…En Afrique, malgré la progression de la maladie coronaire, les valvulopathies rhumatismales restent encore une cause non négligeable de FA, de l'ordre de 25% dans deux séries africaines [3,4]. Mais quel qu'en soit l'origine, la FA est associée, à long terme, aux risques de complications notamment cardiaques et cérébrales.…”