1
|
Coelho P, Mascarenhas K, Rodrigues J, Rodrigues F. Investigation of Electrocardiographic Changes in Individuals with Three or More Cardiovascular Risk Factors on Santiago Island-The Cross-Sectional PrevCardio.CV Study. J Pers Med 2024; 14:876. [PMID: 39202067 PMCID: PMC11355878 DOI: 10.3390/jpm14080876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
Cerebrocardiovascular diseases represent one of the greatest public health concerns globally. In Cabo Verde, non-communicable diseases, such as cerebrocardiovascular diseases, have become leading causes of morbidity and mortality. This study aimed to correlate risk factors with cardiac electrical changes in adult individuals residing on Santiago Island-Cabo Verde. A cross-sectional population-based study using simple random sampling was conducted in 2021 with individuals aged 18 and over, of both sexes, having authorization 35/2021 from the Cabo Verde Ethics Commission. The sample size was calculated based on Santiago Island's projected population for 2021, considering an estimated prevalence of 50%, a 95% confidence interval, and a standard error of 4%, resulting in a sample of 599 individuals. The data were collected through a questionnaire on risk factors and cerebrocardiovascular diseases, blood pressure measurement, capillary blood glucose evaluation, and a 12-lead electrocardiogram. The study sample was predominantly female (54.8%), with the largest age group being 18-27 years (21%). Among the sample, 9.3% had no risk factors, 27.5% had one risk factor, 36.2% had two risk factors, and 26.9% had three or more risk factors. Of those who underwent electrocardiography, 60.24% showed electrocardiographic changes, with the most prevalent being ventricular repolarization changes, nonspecific repolarization changes, and early repolarization. A relationship was observed between cerebrocardiovascular disease risk factors and the electrocardiographic changes found in the study participants.
Collapse
Affiliation(s)
- Patrícia Coelho
- Sport Physical Activity and Health Research & Innovation Center (Sprint), Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal;
| | - Kelly Mascarenhas
- Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal;
| | - Júlio Rodrigues
- Instituto Nacional de Saúde Pública de Cabo Verde, Cidade da Praia 7600, Cape Verde;
| | - Francisco Rodrigues
- Sport Physical Activity and Health Research & Innovation Center (Sprint), Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal;
| |
Collapse
|
2
|
Mengie A, Admassu E, Habtamu D, Berhie AY, Mulatu K, Lidetu T. Prevalence and associated factors of atrial fibrillation among patients with rheumatic heart disease attending public referral hospitals in Bahir Dar city, Northwest Ethiopia, 2023. BMC Cardiovasc Disord 2024; 24:434. [PMID: 39160460 PMCID: PMC11331767 DOI: 10.1186/s12872-024-04092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a supraventricular arrhythmia associated with uncoordinated atrial activation. Atrial fibrillation is complication of rheumatic heart disease and is associated with substantial morbidity and mortality. It is a growing public health problem and economic and social burden. Studies investigating the prevalence and factors associated with atrial fibrillation among chronic rheumatic heart disease patients in Ethiopia are scarce. Therefore, this study aimed to determine the prevalence and factors associated with atrial fibrillation in patients with chronic rheumatic heart disease. METHODS AND MATERIALS A hospital-based cross-sectional study was conducted. A total of 410 patients were selected using a systematic random sampling method. The data were entered into Epi-Data version 4.6 and subsequently exported to SPSS version 26 software for analysis. A binary logistic regression model was applied to identify significant variables related to AF. RESULTS In this study, 410 patient charts were reviewed. The prevalence of atrial fibrillation was 43% (95% CI of 38% up to 48%). Male (AOR = 3.81, 95% CI 2.00-7.26), age greater than 30 years (AOR = 7.26, 95% CI 3.93-13.41), heart failure (AOR = 4.65, 95% CI 2.39-9.04), mitral valve stenosis (AOR = 6.36, 95% CI 2.92-13.87), and left atrial diameter enlargement (AOR = 3.41, 95% CI 1.64-7.09) were associated with atrial fibrillation. CONCLUSIONS AND RECOMMENDATIONS Atrial fibrillation leads patients to frequent hospital admission and increases hospital mortality. As a result, health care professionals need to pay more attention to and apply more clinical treatment for older patients, those with heart failure, those with mitral valve stenosis, and those with left atrial diameter enlargement-associated causes of atrial fibrillation.
Collapse
Affiliation(s)
- Adanech Mengie
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eleni Admassu
- Department of Reproductive Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desiyalew Habtamu
- Department of Public Health Emergency, Humedica e.V, Addis Ababa, Ethiopia
| | - Alemshet Yirga Berhie
- Department of Adult Health Nursing, College of Medicine and Health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu
- Department of Epidemiology and Biostatistics, College of Medicine and Health sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadios Lidetu
- College of Health Sciences, Debark University, Debark, Ethiopia.
| |
Collapse
|
3
|
Taizhanova D, Bazarova N, Kalimbetova A, Gartung T, Bodaubay R, Muratbekova S, Rustembekkyzy Z. Risk Factors for the Development of Atrial Fibrillation in the Kazakh Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Atrial fibrillation (AF) is the most common persistent heart rhythm disorder.
AIM: Assessment of clinical predictors of atrial fibrillation in the Kazakh population.
METHODS: An analytical clinical and epidemiological study of 75 patients with AF of Kazakh nationality. Descriptive analysis of medical records was carried out and the results of laboratory and instrumental research methods. Statistical analysis was carried out using the Statistica 6.0 Software package from StatSoft Inc. (USA) and MS Excel.
RESULTS: In the majority of the studied patients (86.7%), atrial fibrillation was associated with hypertension, in 49.3% of patients was diagnosed with coronary artery disease. A permanent form of atrial fibrillation was observed in 63%, in 20% AF manifested itself in the form of paroxysms, in 17% AF was persistent. AF, which arose against the background of CHF, was established in 41.3% of the patients studied by us, while a decrease in LVEF below 40% was observed in 21.3% of the examined patients. In our study, diabetes mellitus was diagnosed as a comorbid pathology in 24% of patients and diabetes mellitus correlated with permanent AF in 66.7%. Thyroid pathology was observed in 9.3% cases. CRHD as a concomitant disease occurred in 12% of cases. In 5.7% of cases, AF was registered as idiopathic (primary) without a history of cardiovascular and concomitant pathology. Smoking as a risk factor was observed in 16%, alcohol consumption, was noted by 8 patients (10.7%). In 40% of cases, patients with AF were obese, 45.3% of the patients were overweight (BMI ≥25).
Collapse
|
4
|
Bukata IT, Tegene E, Gobena T, Woldesenbet YM. Prevalence and determinants of cardiac arrhythmias and conduction anomalies in adults aged ≥ 40 years in Jimma Town, Southwest of Ethiopia: a cross-sectional study. Afr Health Sci 2022; 22:236-246. [PMID: 36407368 PMCID: PMC9652622 DOI: 10.4314/ahs.v22i2.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The prevalence of cardiac arrhythmia (CA) in the Ethiopian population is unknown. A community study was conducted to assess the magnitude and predictors of CAs in adults aged≥40 years in Jimma Town. Methods A community-based cross-sectional study was conducted in Jimma town from May to July 2017. A total of 634 adults aged 40 years or older were selected using a systematic sampling technique from six kebeles of the Town. Study participants were screened for CA using a 12-lead ECG machine. Face-to-face interviews, anthropometric, important clinical measurements were performed. Data analysis was done using SPSS for windows version 21.0. Results A total of 634 study participants, significant CA occurred in 217 individuals (34.2%). Conduction abnormalities and sinus bradycardia were the commonest findings (25.4%). Premature beats (ventricular 1.9%, atrial 1.1%) and atrioventricular nodal reentrant tachycardia (2.1%) were the next most frequent arrhythmias. Arrhythmias were independently associated with smoking(AOR=1.9;P=.047), hypertension(AOR=1.5;P=.02), heart failure(AOR=2.06;P=.023), prior stroke(AOR=4.9;P=.001), previous history of MI(AOR=1.78;P=.039), vigorous intensity activities(AOR=0.56;P=.024), solidified vegetable oil consumption(AOR=3.5;P=.004), and occupation(pensioner, none)[AOR=1.7;P=.017]. Conclusions CA is highly prevalent in Jimma. Hypertension and history of heart diseases are the most potent predictors of cardiac arrhythmia. Large-scale screening for early detection of arrhythmia has important implications for treatment.
Collapse
Affiliation(s)
- Iyasu Tadesse Bukata
- Lecturer of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251912492329; P.O.Box: 378, Jimma, Ethiopia
| | - Elsa Tegene
- Assistant professor of internal medicine, Department of internal medicine, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911769176; P.O.Box: 378, Jimma, Ethiopia
| | - Teshome Gobena
- Assistant professor of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911487658; P.O.Box: 378, Jimma, Ethiopia
| | - Yohannes Markos Woldesenbet
- Lecturer of medical physiology, School of Medicine, College of Medicine and Health Sciences, Wolaita Sodo University, WolaitaSodo, Ethiopia: , phone: +251911016539; P.O.Box: 138, WolaitaSodo, Ethiopia
| |
Collapse
|
5
|
Bukata IT, Tegene E, Gobena T, Woldesenbet YM. Prevalence and determinants of cardiac arrhythmias and conduction anomalies in adults aged ≥ 40 years in Jimma Town, Southwest of Ethiopia: a cross-sectional study. Afr Health Sci 2022; 22:210-219. [PMID: 36032455 PMCID: PMC9382499 DOI: 10.4314/ahs.v22i1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of cardiac arrhythmia (CA) in the Ethiopian population is unknown. A community study was conducted to assess the magnitude and predictors of CAs in adults aged≥40 years in Jimma Town. Methods A community-based cross-sectional study was conducted in Jimma town from May to July 2017. A total of 634 adults aged 40 years or older were selected using a systematic sampling technique from six kebeles of the Town. Study participants were screened for CA using a 12-lead ECG machine. Face-to-face interviews, anthropometric, important clinical measurements were performed. Data analysis was done using SPSS for windows version 21.0. Results A total of 634 study participants, significant CA occurred in 217 individuals (34.2%). Conduction abnormalities and sinus bradycardia were the commonest findings (25.4%). Premature beats (ventricular 1.9%, atrial 1.1%) and atrioventricular nodal reentrant tachycardia (2.1%) were the next most frequent arrhythmias. Arrhythmias were independently associated with smoking(AOR=1.9;P=.047), hypertension(AOR=1.5;P=.02), heart failure(AOR=2.06;P=.023), prior stroke(AOR=4.9;P=.001), previous history of MI(AOR=1.78;P=.039), vigorous intensity activities(AOR=0.56;P=.024), solidified vegetable oil consumption(AOR=3.5;P=.004), and occupation(pensioner, none)[AOR=1.7;P=.017]. Conclusion CA is highly prevalent in Jimma. Hypertension and history of heart diseases are the most potent predictors of cardiac arrhythmia. Large-scale screening for early detection of arrhythmia has important implications for treatment.
Collapse
Affiliation(s)
- Iyasu Tadesse Bukata
- Lecturer of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251912492329; P.O.Box: 378, Jimma, Ethiopia
| | - Elsa Tegene
- Assistant professor of internal medicine, Department of internal medicine, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911769176; P.O.Box: 378, Jimma, Ethiopia
| | - Teshome Gobena
- Assistant professor of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911487658; P.O.Box: 378, Jimma, Ethiopia
| | - Yohannes Markos Woldesenbet
- Lecturer of medical physiology, School of Medicine, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia: , phone: +251911016539; P.O.Box: 138, Wolaita Sodo, Ethiopia
| |
Collapse
|
6
|
Freedman B, Hindricks G, Banerjee A, Baranchuk A, Ching CK, Du X, Fitzsimons D, Healey JS, Ikeda T, Lobban TCA, Mbakwem A, Narasimhan C, Neubeck L, Noseworthy P, Philbin DM, Pinto FJ, Rwebembera J, Schnabel RB, Svendsen JH, Aguinaga L, Arbelo E, Böhm M, Farhan HA, Hobbs FDR, Martínez-Rubio A, Militello C, Naik N, Noubiap JJ, Perel P, Piñeiro DJ, Ribeiro AL, Stepinska J. World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update. Glob Heart 2021; 16:41. [PMID: 34211827 PMCID: PMC8162289 DOI: 10.5334/gh.1023] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.
Collapse
Affiliation(s)
- Ben Freedman
- Heart Research Institute, University of Sydney, Sydney, AU
| | | | | | | | | | - Xin Du
- Beijing Anzhen Hospital, Capital Medical University, CN
| | | | | | | | - Trudie C. A. Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford Upon Avon, UK
| | - Amam Mbakwem
- Lagos University Teaching Hospital, Idi Araba, Lagos, NG
| | | | | | | | | | - Fausto J. Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisboa, PT
| | | | | | | | | | - Elena Arbelo
- Hospital Clinic de Barcelona, Universitat de Barcelona, ES
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Hornburg/Saar, DE
| | | | | | | | | | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi, IN
| | | | | | | | | | | |
Collapse
|
7
|
Mouton JP, Blockman M, Sekaggya-Wiltshire C, Semakula J, Waitt C, Pirmohamed M, Cohen K. Improving anticoagulation in sub-Saharan Africa: What are the challenges and how can we overcome them? Br J Clin Pharmacol 2021; 87:3056-3068. [PMID: 33586223 PMCID: PMC8359270 DOI: 10.1111/bcp.14768] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/04/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Patients in sub-Saharan Africa generally have poor anticoagulation control. We review the potential reasons for this poor control, as well as the potential solutions. Challenges include the affordability and centralisation of anticoagulation care, problems with access to medicines and international normalised ratio monitoring, the lack of locally validated standardized dosing protocols, and low levels of anticoagulation knowledge among healthcare workers and patients. Increasing numbers of patients will need anticoagulation in the future because of the increasing burden of noncommunicable disease in the region. We propose that locally developed "warfarin care bundles" which address multiple anticoagulation challenges in combination may be the most appropriate solution in this setting currently.
Collapse
Affiliation(s)
- Johannes P Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Jerome Semakula
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catriona Waitt
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
8
|
Semakula JR, Kisa G, Mouton JP, Cohen K, Blockman M, Pirmohamed M, Sekaggya-Wiltshire C, Waitt C. Anticoagulation in sub-Saharan Africa: Are direct oral anticoagulants the answer? A review of lessons learnt from warfarin. Br J Clin Pharmacol 2021; 87:3699-3705. [PMID: 33624331 DOI: 10.1111/bcp.14796] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/19/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Warfarin has existed for >7 decades and has been the anticoagulant of choice for many thromboembolic disorders. The recent introduction of direct-acting oral anticoagulants (DOACs) has, however, caused a shift in preference by healthcare professionals all over the world. DOACs have been found to be at least as effective as warfarin in prevention of stroke in patients with atrial fibrillation and in treatment of venous thromboembolism. In sub-Saharan Africa, however, the widespread use of DOACs has been hampered mainly by their higher acquisition costs. As the drugs come off patent, their use in sub-Saharan Africa is likely to increase. However, very few trials have been conducted in African settings, and safety concerns will need to be addressed with further study before widespread adoption into clinical practice.
Collapse
Affiliation(s)
- Jerome Roy Semakula
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Geraldine Kisa
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Johannes P Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | | | - Catriona Waitt
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
9
|
Izzo C, Vitillo P, Di Pietro P, Visco V, Strianese A, Virtuoso N, Ciccarelli M, Galasso G, Carrizzo A, Vecchione C. The Role of Oxidative Stress in Cardiovascular Aging and Cardiovascular Diseases. Life (Basel) 2021; 11:60. [PMID: 33467601 PMCID: PMC7829951 DOI: 10.3390/life11010060] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Aging can be seen as process characterized by accumulation of oxidative stress induced damage. Oxidative stress derives from different endogenous and exogenous processes, all of which ultimately lead to progressive loss in tissue and organ structure and functions. The oxidative stress theory of aging expresses itself in age-related diseases. Aging is in fact a primary risk factor for many diseases and in particular for cardiovascular diseases and its derived morbidity and mortality. Here we highlight the role of oxidative stress in age-related cardiovascular aging and diseases. We take into consideration the molecular mechanisms, the structural and functional alterations, and the diseases accompanied to the cardiovascular aging process.
Collapse
Affiliation(s)
- Carmine Izzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Paolo Vitillo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Andrea Strianese
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Nicola Virtuoso
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
- Department of Angio-Cardio-Neurology, Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Isernia, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.I.); (P.V.); (P.D.P.); (V.V.); (A.S.); (N.V.); (M.C.); (G.G.); (A.C.)
- Department of Angio-Cardio-Neurology, Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Isernia, Italy
| |
Collapse
|
10
|
Yadeta D, Walelgne W, Fourie JM, Scholtz W, Scarlatescu O, Nel G, Gebremichael M. PASCAR and WHF Cardiovascular Diseases Scorecard project. Cardiovasc J Afr 2021; 32:37-46. [PMID: 33646240 PMCID: PMC8756013 DOI: 10.5830/cvja-2021-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Data collected for the World Heart Federation's Scorecard project regarding the current state of cardiovascular disease prevention, control and management, along with related non-communicable diseases in Ethiopia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the accompanying infographic. Information was collected using open-source data sets from the World Bank, the World Health Organization, the Institute for Health Metrics and Evaluation, the International Diabetes Federation and relevant government publications.
Collapse
Affiliation(s)
- Dejuma Yadeta
- The Society of Cardiac Professionals in Ethiopia, Federal Democratic Republic of Ethiopia
| | - Wubaye Walelgne
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, United States
| | - Jean M Fourie
- Pan-African Society of Cardiology, Cape Town, South Africa
| | - Wihan Scholtz
- Pan-African Society of Cardiology, Cape Town, South Africa.
| | | | - George Nel
- Pan-African Society of Cardiology, Cape Town, South Africa
| | - Mussie Gebremichael
- Diseases Prevention and Control Directorate, Ministry of Health, Federal Democratic Republic of Ethiopia
| |
Collapse
|
11
|
Santos IS, Goulart AC, Olmos RD, Thomas GN, Lip GYH, Lotufo PA, Benseñor IM. Atrial fibrillation in low- and middle-income countries: a narrative review. Eur Heart J Suppl 2020; 22:O61-O77. [PMID: 33380945 PMCID: PMC7753884 DOI: 10.1093/eurheartj/suaa181] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Preventing premature non-communicable disease mortality necessitates a thorough review of one of the most important risk factors for stroke, which is atrial fibrillation (AF). The latter and AF-related stroke are still considered to be problems of high-income countries and are frequently overlooked in low- and middle-income countries (LMICs). In this narrative review, we provide an overview of studies that evaluated at least one of the following determinants of AF burden in LMICs: current epidemiology and trends, stroke prevention, health outcomes, and economic burden. Studies focusing on samples close to the general population (including community- and primary care-based samples) indicate sex-specific prevalence rates up to 7.4% in LMICs. Although AF prevalence is still higher in high-income countries than LMICs, the gap in AF burden between these two groups has been reducing in the past three decades. Oral anticoagulant (OAC) therapy for stroke prevention is underused in LMICs, and there are little data on OAC therapy in relation to stroke risk scores, such as CHA2DS2-VASc. Available data also points to higher morbidity and mortality for patient with AF in LMICs than their counterparts in high-income countries. Data on the consequent economic burden in LMICs is scarce, but it is reasonable to consider it will follow the same trend as that observed for health outcomes. Raising the visibility of AF as a public health problem in LMICs is necessary as a first step to providing adequate care for patients with this condition.
Collapse
Affiliation(s)
- Itamar S Santos
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Cidade Universitária, São Paulo 05508-000, Brazil
- Internal Medicine Deparment, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Cidade Universitária, São Paulo 05508-000, Brazil
- Internal Medicine Deparment, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo D Olmos
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Cidade Universitária, São Paulo 05508-000, Brazil
- Internal Medicine Deparment, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - G Neil Thomas
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gregory Y H Lip
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Cidade Universitária, São Paulo 05508-000, Brazil
- Internal Medicine Deparment, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Cidade Universitária, São Paulo 05508-000, Brazil
- Internal Medicine Deparment, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
12
|
Endewunet E, Tadesse A, Adane A, Abdulkadir M. Appropriate use of anti-thrombotic therapy in patients with atrial fibrillation at single-center experience, Northwest Ethiopia. BMC Cardiovasc Disord 2020; 20:375. [PMID: 32807083 PMCID: PMC7433135 DOI: 10.1186/s12872-020-01659-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the commonest clinically significant ECG-evidenced sustained cardiac arrhythmia in clinical practice. Disability and mortality attributed to AF is high in low-income regions like sub-Saharan Africa. The risk of stroke/TIA in patients with AF can be significantly reduced with anti-thrombotic therapy. Despite the existing evidence of its benefit, significant percentages of AF patients eligible for anti-thrombotic therapy are undertreated in the region. METHODS A hospital-based cross-sectional study was conducted to determine the appropriate use of anti-thrombotic therapy in patients with AF between December 1, 2018 and September 30, 2019 at Cardiac Clinic, University of Gondar hospital, Northwest Ethiopia. Consecutive sampling method was used to recruit 210 study subjects. Patients were interviewed to obtain socio-demographic data. Relevant medical history and laboratory parameters were obtained from patients' records. Diagnosis of atrial fibrillation was based on detection of irregular arterial pulse and presence of 'f' waves on 12-lead ECG tracing. Clinical evaluation, echocardiography, chest X-ray and blood chemistry were used to diagnose underlying causes of AF. Data was entered into EPI Info version 4.4.1 and analyzed using SPSS version 20. Bi-variate and multi-variate logistic regression analyses were used to identify associated factors with appropriate use of anti-thrombotic therapy in patients with atrial fibrillation. P-values < 0.05 were used to declare significant association. RESULTS A total of 210 patients were included in the study. The mean age of patients was 51.29 ± 17.2 years. Two-thirds (145/210) of participants were females. Seventy-four (35%) had valvular AF, while 136/210 (65%) had non-valvular AF. Sixty-six percent (139/210) of study subjects were appropriately treated with anti-thrombotic therapy. Appropriately treated subjects in valvular AF group and non-valvular AF group were 58/74 (78%) and 81/136 (60%) respectively. On multi-variate analysis, 'can afford for regular INR monitoring' (AOR = 2.60 95% CI: 1.10-6.10, P = 0.001) was significantly associated with appropriate use of anti-thrombotic therapy. CONCLUSION Sixty-six percent of AF patients eligible for anti-thrombotic therapy were appropriately treated. Intervention program to access 'regular INR monitoring' should be practiced to escalate utilization rate of anti-thrombotic therapy (warfarin) in eligible AF patients.
Collapse
Affiliation(s)
- Ermiyas Endewunet
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Aynishet Adane
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohamed Abdulkadir
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
13
|
Scheenstra B, van 't Hof A, Spreeuwenberg M, Linz D. From calculating cardiovascular risk factors in Honduras towards a universal cardiovascular risk model. IJC HEART & VASCULATURE 2020; 27:100485. [PMID: 32310239 PMCID: PMC7154309 DOI: 10.1016/j.ijcha.2020.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Bart Scheenstra
- Department of Cardiology. Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Arnoud van 't Hof
- Department of Cardiology. Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Marieke Spreeuwenberg
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology. Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| |
Collapse
|
14
|
Linz D, Ammirati E, Dan GA, Heijman J, Dobrev D. Highlights from the International Journal of Cardiology Heart & Vasculature: Heart failure, atrial fibrillation, coronary artery disease and myocardial infarction. IJC HEART & VASCULATURE 2020; 25:100443. [PMID: 31890863 PMCID: PMC6923494 DOI: 10.1016/j.ijcha.2019.100443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Gheorghe-Andrei Dan
- "Carol Davila" University of Medicine, Colentina University Hospital - Cardiology Department, Bucharest, Romania
| | - Jordi Heijman
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
15
|
Noubiap JJ, Nyaga UF. A review of the epidemiology of atrial fibrillation in sub-Saharan Africa. J Cardiovasc Electrophysiol 2019; 30:3006-3016. [PMID: 31596016 DOI: 10.1111/jce.14222] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 01/05/2023]
Abstract
This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub-Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community-based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one-third of patients with AF, and valvular heart disease (12.3%-44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.
Collapse
Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| |
Collapse
|