Abstract
BackgroundAtrial fibrillation (AF) is the commonest clinically significant ECG-evidenced sustained cardiac arrhythmia in clinical practice. Disability and mortality attributed to AF is high in low-income regions like sub-Saharan Africa. The risk of stroke/TIA in patients with AF can be significantly reduced with anti-thrombotic therapy. Despite the existing evidence of its benefit, significant percentages of AF patients eligible for anti-thrombotic therapy are undertreated in the region.MethodsA hospital-based cross-sectional study was conducted to determine the appropriate use of anti-thrombotic therapy in patients with AF between December 1, 2018 and September 30, 2019 at Cardiac Clinic, University of Gondar hospital, Northwest Ethiopia. Consecutive sampling method was used to recruit 210 study subjects. Patients were interviewed to obtain socio-demographic data. Relevant medical history and laboratory parameters were obtained from patients’ records. Diagnosis of atrial fibrillation was based on detection of irregular arterial pulse and presence of ‘f’ waves on 12-lead ECG tracing. Clinical evaluation, echocardiography, chest X-ray and blood chemistry were used to diagnose underlying causes of AF. Data was entered into EPI Info version 4.4.1 and analyzed using SPSS version 20. Bi-variate and multi-variate logistic regression analyses were used to identify associated factors with appropriate use of anti-thrombotic therapy in patients with atrial fibrillation. P-values < 0.05 were used to declare significant association.ResultsA total of 210 patients were included in the study. The mean age of patients was 51.29 ± 17.2 years. Two-thirds (145/210) of participants were females. Seventy-four (35%) had valvular AF, while 136/210 (65%) had non-valvular AF. Sixty-six percent (139/210) of study subjects were appropriately treated with anti-thrombotic therapy. Appropriately treated subjects in valvular AF group and non-valvular AF group were 58/74 (78%) and 81/136 (60%) respectively. On multi-variate analysis, ‘can afford for regular INR monitoring’ (AOR = 2.60 95% CI: 1.10–6.10, P = 0.001) was significantly associated with appropriate use of anti-thrombotic therapy.ConclusionSixty-six percent of AF patients eligible for anti-thrombotic therapy were appropriately treated. Intervention program to access ‘regular INR monitoring’ should be practiced to escalate utilization rate of anti-thrombotic therapy (warfarin) in eligible AF patients.
Highlights
Atrial fibrillation (AF) is the commonest clinically significant ECG-evidenced sustained cardiac arrhythmia in clinical practice
The burden of AF is greater in developed countries, disability and mortality attributed to AF is maximal in developing countries due to limited health care access [1,2,3,4,5,6]
Rheumatic heart disease is the major cause of AF in sub-Saharan Africa, non-valvular cardiac causes are rising due to epidemiological transition in the region [5,6,7,8]
Summary
Atrial fibrillation (AF) is the commonest clinically significant ECG-evidenced sustained cardiac arrhythmia in clinical practice. Despite the existing evidence of its benefit, significant percentages of AF patients eligible for anti-thrombotic therapy are undertreated in the region. Despite the existing evidences and guidelines, several studies have demonstrated suboptimal use of oral anti-thrombotic therapy in clinical practice. Predictors of suboptimal use in eligible AF patients include, but not restricted to, female sex, elderly (age ≥ 75 years), rural residency, paroxysmal AF type, lower CHA2DS2VASc score, co-existing co-morbidity type, fear of bleeding complication, previous bleeding episodes, limited access to or high cost of INR monitoring, limited opportunity to implement guideline, and health care setting type [3,4,5,6,7, 9, 13,14,15]
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