9 / 76
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 3, May/June 2018
AFRICA
139
Cardiovascular Topics
Prevalence, clinical characteristics and outcomes of
valvular atrial fibrillation in a cohort of African patients
with acute heart failure: insights from the THESUS-HF
registry
Mahmoud U Sani, Beth A Davison, Gad Cotter, Bongani M Mayosi, Christopher Edwards, Okechukwu
S Ogah, Albertino Damasceno, Dike B Ojji, Anastase Dzudie, Charles Mondo, Charles Kouam Kouam,
Ahmed Suliman, Gerald Yonga, Serigne Abdou Ba, Fikru Maru, Bekele Alemayehu, Karen Sliwa
Abstract
Introduction:
Rheumatic heart disease (RHD) is the common-
est cause of valvular heart disease and a common cause of
heart failure in sub-Saharan Africa (SSA). Atrial fibrillation
(AF) complicates RHD, precipitates and worsens heart fail-
ure and cause unfavourable outcomes. We set out to describe
the prevalence, clinical characteristics and outcomes of valvu-
lar atrial fibrillation in a cohort of African patients with acute
heart failure (AHF).
Methods:
The sub-Saharan Africa Survey of Heart Failure
(THESUS-HF) was a prospective, observational survey of
AHF in nine countries. We collected demographic data, medi-
cal history and signs and symptoms of HF. Electrocardiograms
(ECGs) were done in a standard fashion. AF was defined as
either a history of AF or AF on the admission ECG. Using
Cox regression models, we examined the associations of AF
with all-cause death over 180 days and a composite endpoint
of all-cause death or readmission over 60 days.
Results:
There were 1 006 patients in the registry. The mean age
was 52.3 years and 50.8% were women. AF was present in 209
(20.8%) cases. Those with AF were older (57.1 vs 51.1 years),
more likely to be female (57.4 vs 49.1%), had significantly lower
systolic (125 vs 132 mmHg) and diastolic (81 vs 85 mmHg)
blood pressure (BP), and higher heart rates (109 vs 102 bpm).
Ninety-two (44%) AF patients had valvular heart disease. The
presence of AF was not associated with the primary endpoints,
but having valvular AF predicted death within 180 days.
Conclusion:
AF was present in one-fifth of African patients
with AHF. Almost half of the AF patients had valvular
disease (RHD) and were significantly younger and at risk
of dying within six months. It is important to identify these
high-risk patients and prioritise their management, especially
in SSA where resources are limited.
Department of Medicine, Bayero University and Aminu
Kano Teaching Hospital, Kano, Nigeria
Mahmoud U Sani, MB BS, FWACP, FACP, FACC, sanimahmoud@
yahoo.comMomentum Research, Inc, Durham, North Carolina, United
States of America
Beth A Davison, PhD
Gad Cotter MD, FACC
Christopher Edwards, BSc
Department of Medicine, GF Jooste and Groote Schuur
Hospitals, University of Cape Town, Cape Town, South Africa
Bongani M Mayosi, DPhil, FCP (SA)
Department of Medicine, University College Hospital,
Ibadan, Nigeria
Okechukwu S Ogah, MB BS, FWACP
Faculty of Medicine, Eduardo Mondlane University,
Maputo, Mozambique
Albertino Damasceno, MD, PhD
Department of Medicine, University of Abuja Teaching
Hospital, Abuja, Nigeria
Dike B Ojji, MB BS, PhD
Department of Internal Medicine, Douala General Hospital
and Buea Faculty of Health Sciences, Douala, Cameroon
Anastase Dzudie, MD, PhD
Charles Kouam Kouam, MD
Uganda Heart Institute, Kampala, Uganda
Charles Mondo, MB ChB, PhD
Faculty of Medicine, University of Khartoum, Khartoum,
Sudan
Ahmed Suliman, MD
Department of Medicine, Aga Khan University, Nairobi, Kenya
Gerald Yonga, MD, PhD
Service de Cardiologie, Faculty of Medicine, Dakar, Senegal
Abdou Ba, MD, PhD
Addis Cardiac Hospital, Addis Ababa, Ethiopia
Fikru Maru, MD
Bekele Alemayehu, MD
Hatter Institute for Cardiovascular Research in Africa,
Department of Medicine, Faculty of Health Sciences,
University of Cape Town, South Africa
Karen Sliwa, MD, PhD