Cardiovascular Journal of Africa: Vol 24 No 2 (March 2013)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013 6 AFRICA
Cardiovascular Topics
Clinical characteristics and outcomes of atrial fibrillation
and flutter at the Aga Khan University Hospital, Nairobi
JAY SHAVADIA, GERALD YONGA, SITNA MWANZI, ASHNA JINAH, ABEDNEGO MORIASI, HARUN OTIENO
Abstract
Introduction: Scant data exist on the epidemiology and clini-
cal characteristics of atrial fibrillation inKenya.Traditionally,
atrial fibrillation (AF) in sub-Saharan Africa is as a result of
rheumatic valve disease. However, with the economic tran-
sition in sub-Saharan Africa, risk factors and associated
complications of this arrhythmia are likely to change.
Methods: A retrospective observational survey was carried
out between January 2008 and December 2010. Patients with
a discharge diagnosis of either atrial fibrillation or flutter
were included for analysis. The data-collection tool included
clinical presentation, risk factors and management strategy.
Follow-up data were obtained from the patients’ medical
records six months after the index presentation.
Results: One hundred and sixty-two patients were recruited
(mean age 67 ± 17 years, males 56%). The distribution
was paroxysmal (40%), persistent (20%) and permanent
AF (40%). Associated co-morbidities included hypertension
(68%), heart failure (38%) diabetes mellitus (33%) and
valvular abnormalities (12%). One-third presented with
palpitations, dizziness or syncope and 15% with a thrombo-
embolic complication as the index AF presentation. Rate-
control strategies were administered to 78% of the patients,
with beta-blockers and digoxin more commonly prescribed.
Seventy-seven per cent had a CHA2DS2VASC score ≥ 2, but
one-quarter did not receive any form of oral anticoagulation.
At the six-month follow up, 6% had died and 12% had been
re-admitted at least once. Of the high-stroke risk patients on
anticoagulation, just over one-half were adequately antico-
agulated.
Conclusion: Hypertension and diabetes mellitus, not rheu-
matic valve disease were the more common co-morbidities.
Stroke risk stratification and prevention needs to be empha-
sised and appropriately managed.
Keywords: atrial fibrillation, clinical characteristics, Kenya,
outcomes
Submitted 1/8/11, accepted 12/9/12
Cardiovasc J Afr 2013; 24: 6–9
DOI: 10.5830/CVJA-2012-064
In developed countries, atrial fibrillation is the most common
sustained rhythm disorder, with prevalence increasing with
age.1,2 This rhythm disorder is associated with mortality and
significant morbidity due to increased stroke risk, heart failure,
hospitalisations and reduced quality of life.3-5 Data from other
parts of Africa support the notion of the ‘double burden of
disease’, grappling with increasing cardiovascular disease in
addition to the existing maternal and child health problems and
infectious disease burden.6
Atrial fibrillation, the global arrhythmia epidemic,
is proposed to have a more severe epidemiology in Africa,
with the incident age being relatively younger and attendant
complications more prevalent,7,8 possibly due to a combination of
rheumatic valve disease burden and non-adherence to established
clinical guidelines. The purpose of this study was to obtain the
epidemiology, predisposing factors, clinical presentation and
outcomes of atrial fibrillation (AF) and atrial flutter (AFL) at a
private urban referral teaching hospital in East Africa.
Methods
This retrospective survey was performed at the Aga Khan
University teaching hospital in Nairobi, Kenya, between January
2008 and December 2010. The Aga Khan University Hospital is
a 256-bed hospital serving predominantly an urban middle- to
high-income community.
Patients over the age of 18 years, who had an
electrocardiographic (ECG) diagnosis of either AF or AFL
during their admission were included in the study. The data were
collected using a data tool that included patient demographics and
clinical presentation, potential risk factors to the development of
AF and AFL, management strategy, and anticoagulation status.
Follow-up data were from the patients’ medical records obtained
six months after the index presentation.
Atrial fibrillation was sub-divided into three main classes:
paroxysmal (initial or recurrent AF episodes terminating
spontaneously within seven days), persistent (non-spontaneously
terminating after seven days or requiring electrical or chemical
cardioversion), and permanent AF (failed rhythm control with
electrical and chemical cardioversion, or cardioversion had
never been attempted). ‘Lone AF’ was defined as an episode in
Department of Cardiology, Aga Khan University Hospital,
Nairobi, Kenya
JAY SHAVADIA, MD,
GERALD YONGA, MD
SITNA MWANZI, MD
ASHNA JINAH, MD
ABEDNEGO MORIASI, MD
HARUN OTIENO, MD