Department of Cardiology, Hopital De La Tour, 1, Avenue J.-D. Maillard, Meyrin, Geneva 1217, Switzerland.
Europace. 2010 Apr;12(4):482-7. doi: 10.1093/europace/euq006. Epub 2010 Feb 23.
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.
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.
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.
本前瞻性研究旨在描述撒哈拉以南非洲国家城市人群中房颤（AF）患者的临床特征，并评估当前指南在该环境下的应用效果。
本前瞻性研究纳入了喀麦隆的 10 名心脏病专家。入组于 2006 年 6 月 1 日开始，2007 年 6 月 30 日结束。符合条件的患者为年龄＞18 岁且在就诊时心电图记录到 AF 的连续患者。在这项研究中，共纳入了 172 例患者（75 例男性，97 例女性；平均年龄 65.8±13 岁）。阵发性、持续性和永久性 AF 的患病率分别为 22.7%、21.5%和 55.8%。156/172 例（90.7%）患者存在潜在的心脏疾病，包括高血压性心脏病（47.7%）、瓣膜性心脏病（25.6%）、扩张型心肌病（15.7%）和冠状动脉疾病（6%）。83.7%（144/172）的患者采用了控制心室率的策略，最常使用的药物是地高辛和胺碘酮。平均 CHADS2 评分为 1.9±1.1，172 例患者中有 158 例（91.9%）的 CHADS2 评分≥1。有口服抗凝指征的患者中，仅 34.2%（54/158）实际接受了抗凝治疗。在 318±124 天的随访中，88 例患者中有 26 例（29.5%）死亡，主要死于心血管原因（26 例中有 15 例）。10 例（16.1%）患者发生非致死性脑栓塞，23 例（26.1%）患者出现严重充血性心力衰竭症状。
喀麦隆 AF 的临床表现比发达国家更为严重。在喀麦隆，控制心室率的策略占主导地位，尽管纳入时 CHADS2 评分较高，但仅有 34.2%的符合条件的患者接受了口服抗凝治疗。喀麦隆 1 年内的死亡率和卒中率非常高，可能是由于口服抗凝治疗使用率较低，以及风湿性二尖瓣疾病和更严重合并症的患病率较高所致。
