Mayet Mohammed, Vallabh Kamil, Hendrikse Clint
University of Cape Town Faculty of Health Sciences, Division of Emergency Medicine, Cape Town, Western Cape, ZA, South Africa.
Mitchells Plain Hospital and Heideveld Hospital, Emergency Centre, Cape Town, Western Cape, ZA, South Africa.
Afr J Emerg Med. 2021 Mar;11(1):39-45. doi: 10.1016/j.afjem.2020.10.013. Epub 2020 Nov 19.
Cerebrovascular disease remains one of the leading causes of morbidity and mortality globally. In South Africa, it was the fourth leading cause of death in 2016, responsible for 5.1% of all deaths - the leading cause of death in individuals 65 years and older. Atrial fibrillation accounts for 15% of all strokes and 25% are diagnosed when patients present with a stroke. We set out to determine the prevalence of atrial fibrillation in patients with confirmed ischaemic strokes in a district level hospital in the Western Cape, South Africa.
This descriptive study was conducted at Mitchells Plain Hospital in Cape Town and data was collected over a one-year period. Patients diagnosed with a stroke were identified from an electronic patient register and relevant radiology and clinical data were sourced retrospectively. The diagnosis of ischaemic stroke was confirmed by a CT scan report and ECGs were independently screened by two Emergency Physicians. Ethical approval was granted by the University of Cape Town Human Research Ethics Committee [790/2018].
The proportion of adult patients with a stroke diagnosis was 2%. Of the included cases, 80% had ischaemic strokes and 11% had haemorrhagic strokes. 11% of all patients with ischaemic strokes had atrial fibrillation, 67% of those presumed new. A total of 60 (15%) of all patients with ischaemic stroke were aged 45 years or younger. The inpatient mortality rate was statistically higher in patients who had atrial fibrillation (26% vs 7%, < 0.001).
With the increasing population life expectancy, and prevalence of cardiovascular disease the prevalence of atrial fibrillation and its complications will increase. Since the risk of stroke related to atrial fibrillation can be reduced significantly by oral anticoagulation, further studies should aim to explore barriers and challenges to effective screening.
脑血管疾病仍然是全球发病和死亡的主要原因之一。在南非，它是2016年第四大死因，占所有死亡人数的5.1%，是65岁及以上人群的主要死因。心房颤动占所有中风病例的15%，25%的病例是在患者中风时被诊断出来的。我们旨在确定南非西开普省一家区级医院确诊的缺血性中风患者中心房颤动的患病率。
这项描述性研究在开普敦的米切尔平原医院进行，数据收集为期一年。从电子患者登记册中识别出被诊断为中风的患者，并回顾性获取相关的放射学和临床数据。缺血性中风的诊断通过CT扫描报告确认，心电图由两名急诊医生独立筛查。开普敦大学人类研究伦理委员会[790/2018]给予了伦理批准。
被诊断为中风的成年患者比例为2%。在纳入的病例中，80%患有缺血性中风，11%患有出血性中风。所有缺血性中风患者中有11%患有心房颤动，其中67%被认为是新发的。所有缺血性中风患者中共有60例（15%）年龄在45岁及以下。有心房颤动的患者住院死亡率在统计学上更高（26%对7%，<0.001）。
随着人口预期寿命的增加以及心血管疾病患病率的上升，心房颤动及其并发症的患病率将会增加。由于口服抗凝治疗可显著降低与心房颤动相关的中风风险，进一步的研究应旨在探索有效筛查的障碍和挑战。
