title: Atrial fibrillation in Africa: clinical characteristics, prognosis, and adherence to guidelines in Cameroon.
abstract: OBJECTIVE
  The purpose of this prospective study was to characterize the clinical profile of patients with atrial fibrillation (AF) in the urban population of a sub-Saharan African country and to assess how successfully current guidelines are applied in that context.
  
  
  RESULTS
  This prospective study involved 10 cardiologists in Cameroon. Enrolment started on 1 June 2006 and ended on 30 June 2007. Consecutive patients were included if they were >18 years and AF was documented on an ECG during the index office visit. In this survey, 172 patients were enrolled (75 males and 97 females; mean age 65.8 +/- 13 years). The prevalence of paroxysmal, persistent, and permanent AF was 22.7, 21.5, and 55.8%, respectively. Underlying cardiac disorders, present in 156/172 patients (90.7%), included hypertensive heart disease (47.7%), valvular heart disease (25.6%), dilated cardiomyopathy (15.7%), and coronary artery disease (6%). A rate-control strategy was chosen in 83.7% of patients (144 of 172) and drugs most commonly used were digoxin and amiodarone. The mean CHADS(2) score was 1.9 +/- 1.1 and 158 of 172 patients (91.9%) had a CHADS(2) score > or =1. Among patients with an indication for oral anticoagulation (OAC), only 34.2% (54 of 158) actually received it. During a follow-up of 318 +/- 124 days, 26 of 88 patients died (29.5%), essentially from a cardiovascular cause (15 of 26). Ten patients (16.1%) had a non-lethal embolic stroke and 23 (26.1%) had symptoms of severe congestive heart failure.
  
  
  CONCLUSIONS
  Clinical presentation of AF in Cameroon is much more severe than in developed countries. A rate-control strategy is predominant in Cameroon and OAC is prescribed in only 34.2% of eligible patients, despite a high CHADS(2) score at inclusion. Death and stroke rate at 1 year are very high in Cameroon possibly because of a lower use of OAC, and a higher prevalence of rheumatic mitral disease and of more severe co-morbidities.
authors.affiliation: Department of Cardiology, Hopital De La Tour, 1, Avenue J.-D. Maillard, Meyrin, Geneva 1217, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Ntep-Gweth
authors.forename: Marc
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Alexandre
authors.initials: A
authors.lastname: Meiltz
authors.forename: Samuel
authors.initials: S
authors.lastname: Kingue
authors.forename: Pierre
authors.initials: P
authors.lastname: Ndobo
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: Antoine
authors.initials: A
authors.lastname: Bloch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*; D002163:Cameroon / Q000453:epidemiology; D002309:Cardiology / Q000592:standards* / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D019538:Health Care Surveys; D006331:Heart Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D000925:Anticoagulants