CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 126 AFRICA References 1. Klerk CPW, Smorenburg SM, Büller HR. Thrombosis prophylaxis in patient populations with a central venous catheter: a systematic review. Arch Int Med 2003; 163(16): 1913–1921. 2. Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of central venous catheters. Clin Radiol 2013; 68(5): 529–544. 3. Revel-Vilk S, Yacobovich J, Tamary H, Goldstein G, Nemet S, Weintraub W, et al. Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer. Cancer 2010; 116(17): 4197–4205. 4. Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, et al. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med 2015; 3(3): 40. 5. Gray BW, Gonzalez R, Warrier KS, Stephens LA, Drongowski RA, Pipe SW, et al. Characterization of central venous catheter-associated deep venous thrombosis in infants. J Pediatr Surg 2012; 47(6): 1159–1166. 6. Burns KEA, McLaren A. Catheter-related right atrial thrombus and pulmonary embolism: a case report and systematic review of the literature. Can Resp J 2009; 16: 751507. 7. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003; 348(12): 1123–1133. 8. Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patientsa randomized controlled trial. J Am Med Assoc 2001; 286(6): 700–707. 9. Linenberger ML. Catheter-related thrombosis: risks, diagnosis, and management. J Natl Compr Canc Netw 2006; 4(9): 889–901. 10. Hashem H, Zeineddin M, Bater R, Amayiri N, Al Qasem W, Hammo B, et al. Thrombosis and anticoagulant therapy among pediatric cancer patients: real-life data. Cureus 2021; 13(12): e20084. 11. Acedo Sánchez JD, Batlle JF, Feijoo JB. Catheter-related thrombosis: a critical review. Support Cancer Ther 2007; 4(3): 145–151. 12. Wallace A, Albadawi H, Patel N, Khademhosseini A, Zhang YS, Naidu S, et al. Anti-fouling strategies for central venous catheters. Cardiovasc Diagn Ther 2017; 7(Suppl 3): S246–S257. 13. Geerts W. Central venous catheter–related thrombosis. Hematology 2014; 2014(1): 306–311. 14. Citla Sridhar D, Abou-Ismail MY, Ahuja SP. Central venous catheterrelated thrombosis in children and adults. Thromb Res 2020; 187: 103–112. Call to re-assess growing burden of atrial fibrillation and its consequences Heart failure, not stroke, is the most common complication of atrial fibrillation (AF), which affects 37 million people worldwide, say experts, calling for the profession to more comprehensively estimate the condition’s risk by considering multiple risk factors. AF increases not just risk of heart failure and stroke but also myocardial infarction and death, as well as causing a quantifiable impairment in quality of life, write Jianhua Wu and Ramesh Nadarajah in the Br Med J. They say that in the UK National Health Service alone, more new cases of AF are diagnosed each year than the four most common causes of cancer combined, and direct expenditure on AF has reached £2.5bn. They add that improvements to patient prognosis are likely to require a broader perspective on the condition’s management beyond prevention of stroke. They write: ‘While the lifetime risk of the condition has been estimated, whether this has changed over the past two decades is unknown. Furthermore, the comparative risks of later sequelae for individuals with AF, and whether trends are temporal, has yet to be reported.’ A recent article by Vinter and colleagues (in the Br Med J) addresses these important knowledge gaps in a nationwide, population-based study using the population of Denmark from 2000 to 2022. The aim was to examine how the lifetime risks of AF and of complications after AF changed over time. Using administrative registry data from 3.5m people, Vinter and colleagues estimate that the lifetime risk of AF for an individual 45 years and older increased from 24.2 to 30.9% between the decades 2000 and 10 and 2011 and 22, a 28% relative increase. This risk was larger in men than in women and in those with prevalent heart failure, myocardial infarction, stroke, diabetes and chronic kidney disease, compared with people who do not have these conditions. Among patients with an incident diagnosis of AF, heart failure was the most frequent complication, with a lifetime risk of 41.2%, double that of stroke (21.4%). Comparing the two pre-specified periods, lifetime risk of heart failure after an AF diagnosis did not change, but absolute lifetime risks declined by 2.5% for stroke and by 3.9% for myocardial infarction. Strengths of this observational study include the capture of data for a nationwide population of 3.5m individuals, and use of sophisticated methods (the Aalen–Johansen estimator) to accurately calculate the cumulative incidence of AF and complications while accounting for left truncation and the competing risk of death. Limitations include the grouping of the population into two 10-year periods, resulting in the loss of temporal resolution; the lack of reporting on ethnic group composition of the study population, which influences lifetime risk of AF; and the absence of subgroup analysis by socio-economic status, which affects incidence and outcomes of AF. Their conclusion was that lifetime risk of AF increased over two decades of follow up. In individuals with AF, about two in five developed heart failure and one in five had a stroke over their remaining lifetime after AF diagnosis, with no or only small improvement over time. Stroke risk and heart failure prevention strategies are needed for people with AF, they said. The finding that lifetime risk of AF has increased over the past two decades is not surprising because many other studies have shown increasing AF incidence. Nonetheless, routinely collected data show that contemporary lifetime risk of AF has increased to one in three because up to 35% of disease burden remains undiagnosed. continued on page 130…
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