Clinical characteristics and complications of patients with atrial fibrillation admitted in Mulago hospital Uganda.

Abstract

Background: Atrial fibrillation (AF) is the most common type of sustained cardiac arrhythmia in adults, accounting for one third of hospitalizations due to the arrhythmia and related complications worldwide. The risk factors for AF are increasing in sub-Saharan Africa Uganda inclusive, and hence a call for adjustments in the evaluation and management of patients with AF yet there is no systematically collected data on the subject. Objective: The main objective of this study was to describe the clinical characteristics and complications among patients with AF admitted to Mulago hospital. Methods: This was a hospital based cross sectional descriptive study in which a total of 102 patients with AF were recruited over three months. AF was defined based on rest ECG features of Irregular R-R interval, absent P wave, with fibrillatory waves. Patient demographics, medical history, and lifestyle related information were collected. A physical examination including height, weight and blood pressure were taken. Echocardiography, electrolytes, thyroid function tests were done to establish any associated risk factors and complications. Data was entered in Epidata 3.1 and analyzed using STATA version 10.0. Data summarized into frequencies and proportions. Chi-square test p-values were used to determine statistical significant associations between study variables at 5% level of significance Results: The mean age of participants was 52 years (SD 21.3), Eighty six of 102 patients studied presented with palpitations (84%). The commonest underlying diagnosis was hypertension in 42% (43/102), Rheumatic heart disease 32% (33/102). The commonest echocardiographic abnormality was chamber dilation which occurred in 76.8% of all patients. Heart failure was the most frequent (50%) complication encountered, acute thromboembolic (stroke) complications were seen in 12.8% (13/102), another complication was LV dysfunction in 20% (20/ 102) Conclusions: Palpitation was the commonest presenting symptom among patients with atrial fibrillation Hypertension was the commonest underlying condition associated with AF in our study, followed by rheumatic heart disease. AF appears to affect individuals at a much younger age compared to developed countries. AF was associated with severe stroke and early death in acute cardio embolic ischemic stroke. Recommendations: All patients with complaints of palpitations, dizziness, syncope, chest pain and features of congestive heart failure should have an ECG to screen them for atrial fibrillation. All patients with hypertension and rheumatic heart disease irrespective of their functional status should have serial ECGs to detect when they first develop atrial fibrillation. Careful cardiac evaluation and appropriate treatment may be needed to improve the outcome in patients with acute stroke and Atrial fibrillation. Large prospective studies are required to better understand the epidemiology, complications and management of AF in Uganda.