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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019
168
AFRICA
Characteristics and 12-month outcome of patients with
atrial fibrillation at a tertiary hospital in Botswana
Julius Chacha Mwita, Cassandra Ocampo, Onkabetse Julia Molefe-Baikai, Monkgogi Goepamang,
Elizabeth Botsile, Jose Gaby Tshikuka
Abstract
Background:
Atrial fibrillation (AF) is the commonest
sustained cardiac arrhythmia associated with high morbid-
ity and mortality rates. Notwithstanding the scale of the
problem, there are sparse data on the characteristics and
outcomes of both valvular and non-valvular AF patients in
sub-Saharan Africa (SSA).
Objective:
This study aimed at describing the clinical features
and outcome of AF patients at a tertiary hospital in Botswana.
Methods:
This prospective study was carried out in the
Princess Marina Hospital in Gaborone, Botswana between
August 2016 and July 2018. We consecutively enrolled 138
(97.8% black Africans) adult patients with electrocardio-
graphically documented AF. Their baseline clinical and
biomedical data were documented, and each patient was
followed up for 12 months. The primary study outcome was
12-month all-cause mortality.
Results:
The mean [standard deviation (SD)] age of enrolled
patients was 66.7 (17.2) years, and 63.8% were females.
Common co-morbidities were hypertension (59.4%), rheu-
matic heart disease (37.7%) and heart failure (35.5%). Stroke/
transient ischaemic attack (TIA) (21.7%) and obesity (34.8%)
were also prevalent. Compared to patients with non-valvular
AF, those with valvular AF were more likely to be female (82
vs 55%,
p
=
0.003), younger (60 vs 75 years,
p
<
0.001), on
anticoagulation (88.6 vs 66%,
p
=
0.005), or have a dilated left
atrium (5.3 vs 4.5 cm,
p
<
0.001). They were also less likely to
present with hypertension (33 vs 72%,
p
<
0.001), stroke/TIA
(nine vs 27%,
p
<
0.017), chronic kidney disease (five vs 20%,
p
<
0.02), or history of cigarette smoking (two vs 13%,
p
=
0.049)
than non-valvular AF patients. The mean (SD) CHA
2
DS
2
-
VASc score in non-valvular AF patients was 3.6 (1.5), and the
median HAS-BLED score was 2.0 [interquartile range (IQR)
1.0–3.0]. During the 12-month follow up, 20 (14.5%) patients
died. Despite differences in baseline characteristics, there was no
difference in mortality rate in patients with valvular compared
to those with non-valvular AF (13.8 vs 15.9%;
p
=
0.746).
Conclusion:
In this study, hypertension, rheumatic heart
disease and heart failure were the most prevalent co-morbid-
ities. AF presented in young people and conferred high
mortality rates in both valvular and non-valvular AF patients.
Prevention and optimal management of AF and associated
co-morbidities are of critical importance.
Submitted 1/1/19, accepted 26/2/19
Published online 27/3/19
Cardiovasc J Afr
2019;
30
: 168–173
www.cvja.co.zaDOI: 10.5830/CVJA-2019-013
Atrial fibrillation (AF) is the most frequent sustained cardiac
arrhythmia of public health importance.
1
The prevalence of
AF has been lower in Africa than in the developed world.
2
The burden of AF in sub-Saharan Africa has, however, been
increasing over the past few decades.
2-4
This trend may partly be
explained by the population ageing and an increasing burden of
chronic non-communicable diseases of lifestyle that predispose
to AF, such as obesity, smoking, hypertension, diabetes and
cardiovascular diseases.
2,5
Unfortunately, these diseases tend to
occur earlier in life among Africans compared to Caucasians.
6
Their presence dramatically magnifies the risk of AF, particularly
non-valvular AF.
1
As a result, patients with non-valvular AF in
Africa tend to be younger than patients in other regions.
7
Due
to the high burden of rheumatic heart disease, patients with
valvular AF in SSA also tend to be younger than those from
developed countries where age-related degenerative valvular
diseases predominate.
7
Given that AF is not a benign disease, AF-related morbidity
and mortality pose another challenge to the young population
in SSA countries where infectious diseases are a burden.
8,9
The
disease is associated with an approximately five-fold increased
risk for stroke, a two-fold increased risk for heart failure, and
two-fold increased risk for mortality.
1,9,10
Despite the extent of
the problem, there are sparse data on the characteristics and
outcomes of both valvular and non-valvular AF patients in
SSA. This information is critical for the identification of patients
needing priority attention to minimise dire consequences. This
study aimed at evaluating the characteristics and outcomes of
patients with valvular and non-valvular AF at a tertiary hospital
in Botswana.
Methods
This prospective study was conducted in the medical in- and
out-patient departments at Princess Marina Hospital (PMH) in
Department of Internal Medicine, Faculty of Medicine,
University of Botswana, Gaborone, Botswana
Julius Chacha Mwita, MD, MMed, MSc,
mwitajc@ub.ac.bwCassandra Ocampo, MD
Onkabetse Julia Molefe-Baikai, MD, MMed, FCP
Department of Medicine, Princess Marina Hospital,
Gaborone, Botswana
Julius Chacha MwitaM.D, MMed, MSc
Cassandra Ocampo, MD
Onkabetse Julia Molefe-Baikai, MD, MMed, FCP
Monkgogi Goepamang, MB ChB, MRCPI
Elizabeth Botsile, MD, MMed, FCP
Department of Family Medicine and Public Health, Faculty
of Medicine, University of Botswana, Gaborone, Botswana
Jose Gaby Tshikuka, DVM, MSc, FRSH, PhD