Demographic, Clinical and Laboratory Characteristics of Atrial Fibrillation as Seen in Medical out-patient Clinics at the Kenyatta National Hospital

Abstract

ABSTRACT Background Atrial fibrillation (AF) is the Commonest sustained arrhythmia encountered in clinical practice with frequent hospitalizations. In Sub-saharan Africa it is presumed to be predominantly valvular. Objective: To determine Demographic, Clinical characteristics and treatment options utilised Ambulatory Atrial Fibrillation (AF) . Design: A descriptive case registry Setting: Medical out-patients at a tertiary referral hospital: Kenyatta National Hospital, Nairobi, Kenya Subjects: Consecutive Medical Out-patient attendees Methods: Daily Case records perusal identified file label of AF from which demographic, clinical, electrocardiographic and treatment data was extracted and a comprehensive clinical evaluation and resting 12-lead ECG recorded. Outcome Measures: Clinical cardiac diagnosis label, Treatment mordalities as rate or rhythm control strategy, anti-thrombotic therapy utilized and anti-coagulation intensity and monitoring over preceeding 6 months Results: Between 18thAugust and 14th November 7,608 files were perused and 211 AF cases enrolled; mean age of 48 yrs.73% were under 65yrs, 68% female. Clinically diagnosed AF had a period prevalence of -3%. AF was found to be predominantly non-valvular in aetiology at 53%.lt was commonly associated with Hypertension at 54%.Rate control was the commonest strategy in use at 83% and the vast majority of our patients were on antithrombotic therapy (60% on Warfarin and 20% on Aspirin) this was similar in VHD and NVHD. Majority of the patients were on 5mg of Warfarin, INR monitoring was only , perfomed 2.5 times in six months and INR range 1.5-8, Mean 2.5 Heart-failure was the commonest recorded complication of AF recorded in this study at 47% thrombo-embolic phenomena followed at 12% and major bleeding episodes 0.2% and AF related hospitalization at 14%. Conclusion: AF is not uncommon in the ambulatory setting, mostly valvular in aetiology, being adequately addressed in terms of rate-control and antithrombotic therapy. Intensity of anticoagulation is adequate but it's monitoring is not. AF is complicated by heart failure and thrombo-embolic episodes.