Prevalence and Predictors of Atrial Fibrillation and its Embolic Complications in Patients with Rheumatic Heart Disease at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Abstract

Background: Atrial fibrillation is one of the complications of rheumatic heart disease, with substantial morbidity and mortality. The prevalence and predictors of atrial fibrillation and its thrombo-embolic complications in Ethiopian patients with rheumatic heart disease are unknown. The objective of this study was to determine the prevalence and predictors of atrial fibrillation and its thromboembolic complications.
Methods: A retrospective chart review of 500 patients with rheumatic heart disease at the adult cardiology clinic of Tikur Anbessa Specialized Hospital was carried out from 01 January to 31 June 2016. Data were entered into a pre-tested questionnaire and were analyzed using SPSS version 23.
Results: Records of 500 patients (72% female) with electrocardiographic recordings and echocardiographic reports were available for analysis. Atrial fibrillation was found in 234 (46.8%) of the patients. Predictors of atrial fibrillation were found to be: age ≥50 years (p=0.01), left atrial size ≥45mm (p=0.01), the presence of mitral stenosis (p<0.01) and the presence of tricuspid regurgitation (p=0.01). Cardioembolic events were reported in 67 (9.2%) patients, and the presence of atrial fibrillation (p=0.02) and sub-therapeutic anticoagulation status (p<0.01) were significant predictors of cardioembolic events.
Conclusions and recommendations: The study reveals a high prevalence of atrial fibrillation and cardioembolic events in Ethiopian patients with rheumatic heart disease. Hence, active screening of atrial fibrillation and optimal anticoagulation are recommended. [Ethiop. J. Health Dev. 2019;33(1):12-16]
Key words: Rheumatic Heart Disease, Atrial Fibrillation, Cardioembolic Complications, Stroke, Ethiopia