title: Clinical characteristics and outcomes of atrial fibrillation and flutter at the Aga Khan University Hospital, Nairobi.
abstract: BACKGROUND
  Scant data exist on the epidemiology and clinical characteristics of atrial fibrillation in Kenya. Traditionally, atrial fibrillation (AF) in sub-Saharan Africa is as a result of rheumatic valve disease. However, with the economic transition 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 thromboembolic 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 CHA(2)DS(2)VASC 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 anticoagulated.
  
  
  CONCLUSIONS
  Hypertension and diabetes mellitus, not rheumatic valve disease were the more common co-morbidities. Stroke risk stratification and prevention needs to be emphasised and appropriately managed.
authors.affiliation: Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya. jay.shavadia@aku.edu
authors.forename: Jay
authors.initials: J
authors.lastname: Shavadia
authors.forename: Gerald
authors.initials: G
authors.lastname: Yonga
authors.forename: Sitna
authors.initials: S
authors.lastname: Mwanzi
authors.forename: Ashna
authors.initials: A
authors.lastname: Jinah
authors.forename: Abednego
authors.initials: A
authors.lastname: Moriasi
authors.forename: Harun
authors.initials: H
authors.lastname: Otieno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D001282:Atrial Flutter / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants