Shavadia Jay, Yonga Gerald, Mwanzi Sitna, Jinah Ashna, Moriasi Abednego, Otieno Harun
Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya.
Cardiovasc J Afr. 2013 Mar;24(2):6-9. doi: 10.5830/CVJA-2012-064.
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.
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.
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.
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.
关于肯尼亚房颤的流行病学和临床特征的数据稀缺。传统上，撒哈拉以南非洲地区的房颤是由风湿性瓣膜病引起的。然而，随着撒哈拉以南非洲地区的经济转型，这种心律失常的危险因素和相关并发症可能会发生变化。
于2008年1月至2010年12月进行了一项回顾性观察研究。纳入出院诊断为房颤或房扑的患者进行分析。数据收集工具包括临床表现、危险因素和管理策略。随访数据来自患者在首次就诊后6个月的病历。
共招募了162例患者（平均年龄67±17岁，男性占56%）。房颤类型分布为阵发性（40%）、持续性（20%）和永久性房颤（40%）。相关合并症包括高血压（68%）、心力衰竭（38%）、糖尿病（33%）和瓣膜异常（12%）。三分之一的患者以心悸、头晕或晕厥就诊，15%的患者以血栓栓塞并发症作为首次房颤表现。78%的患者采用了心率控制策略，其中β受体阻滞剂和地高辛的处方更为常见。77%的患者CHA(2)DS(2)VASC评分≥2，但四分之一的患者未接受任何形式的口服抗凝治疗。在6个月的随访中，6%的患者死亡，12%的患者至少再次入院一次。在接受抗凝治疗的高卒中风险患者中，只有略超过一半的患者抗凝充分。
高血压和糖尿病而非风湿性瓣膜病是更常见的合并症。需要强调并适当管理卒中风险分层和预防。
