Clinical characteristics and management practice among patients diagnosed with atrial ibrillation in Benghazi Libya, A cross sectional study

Abdelhadi H Elkadiki; Mohammed A Ali; Khaled D Alsaeiti

doi:10.4103/LJMS.LJMS_3_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 5 | Issue : 2 | Page : 66-69

Clinical characteristics and management practice among patients diagnosed with atrial ibrillation in Benghazi Libya, A cross sectional study

Abdelhadi H Elkadiki¹, Mohammed A Ali², Khaled D Alsaeiti³
¹ Department of Internal Medicine (Cardiology), Faculty of Medicine, Benghazi University, Benghazi, Libya
² Department of Cardiology, Benghazi Medical Center, Benghazi, Libya
³ Department of Internal Medicine, Libyan International Medical University, Benghazi, Libya

Date of Submission	13-Jan-2021
Date of Acceptance	06-Jun-2021
Date of Web Publication	23-Jul-2021

Correspondence Address:
Dr. Khaled D Alsaeiti
Department of Internal, Medicine, Libyan International Medical University, Benghazi
Libya

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/LJMS.LJMS_3_21

Abstract

Introduction: There are no data so far regarding the frequency and outcome of the different types of atrial fibrillation (AF) in the clinical setting for Libyan patients. Furthermore, it is unknown whether the actual clinical management and therapy of AF in Libya conform to the international guidelines. The aim of this study was to determine the frequency, demographic, and clinical characteristics of AF patients. Patients and Methods: Three hundred patients attending the outpatient clinic and cardiology department at Benghazi Medical Center and National Cardiac Center between May 2020 and October 2020 were included. Patients' data were obtained through medical records using the chart review. Patients were categorized into a clinical type of AF, based on the physician's perception of the AF at the time of presentation. Results: Three hundred patients with an established diagnosis of AF were enrolled, including 210 (70%) females and 90 (30%) males. The mean age at the time of diagnosis was 49.5 ± 21.5 years, with an age range of 29–79 years. Of them 139 (46.3%) were diagnosed as permanent AF, 132 (44%) paroxysmal AF, while new-onset AF was diagnosed in 29 (9.7%). The three clinical categories of AF were enrolled under the care of both cardiologists and internal medicine physicians, but permanent AF patients were more often enrolled under the care of a cardiologist. Patients with permanent AF were older compared with those with paroxysmal subtype (61.8 ± 9 and 50.1 ± 12, respectively), with significant female predominance (P = 0.03), and more often had coronary artery disease (CAD), valvular heart disease, and a previous stroke/TIA (P = 0.01, P = 0.124, and P = 0.002, respectively). Diabetes was the most prevalent associated medical condition, followed by hypertension and hyperlipidemia. CAD was diagnosed among 122 patients. Of permanent AF patients, 28 patients (20.1%) previously suffered from a stroke, mostly TIA, in contrast to 14 patients (10.6%) of the other AF patients. Conclusion: Our AF patients were characterized by an unfavorable cardiovascular risk profile. We recognize a lower rate of oral anticoagulation prescription, which needs further evaluation.

Keywords: Atrial fibrillation, Libya, presentation

How to cite this article:
Elkadiki AH, Ali MA, Alsaeiti KD. Clinical characteristics and management practice among patients diagnosed with atrial ibrillation in Benghazi Libya, A cross sectional study. Libyan J Med Sci 2021;5:66-9

How to cite this URL:
Elkadiki AH, Ali MA, Alsaeiti KD. Clinical characteristics and management practice among patients diagnosed with atrial ibrillation in Benghazi Libya, A cross sectional study. Libyan J Med Sci [serial online] 2021 [cited 2023 Mar 27];5:66-9. Available from: https://www.ljmsonline.com/text.asp?2021/5/2/66/322204

Introduction

Atrial fibrillation (AF) is associated with increased mortality.^[1],[2] Furthermore, AF causes a five-fold rise in stroke risk and frequently coexists with heart failure, both leading to an even further increase in mortality.^[3],[4] Altogether, AF causes a significant economic burden, which has grown in the past decades and is expected to grow even further in the upcoming period with the increasing trend in AF prevalence and hospitalizations.^[5] Therefore, an adequate treatment strategy is warranted. For stroke prevention, numerous trials showed a beneficial effect of anticoagulation above aspirin or placebo in patients with a high risk for stroke, although the risk for bleeding is increased.^[6] In patients with a low risk for stroke, the bleeding risk of anticoagulation therapy outweighs the benefit of stroke prevention, but aspirin is recommended in these patients.^[7] Several population-based studies provided information on the incidence, prevalence, and outcome of AF in the general population.^[1],[2],[8] However, there are no data so far regarding the frequency and outcome of the different types of AF in the clinical setting for Libyan patients. Furthermore, it is unknown whether the actual clinical management and therapy of AF in Libya conform to the international guidelines. Therefore, we perform a study on the prevalence, demographic, and clinical characteristics of AF patients among the Libyan population in Benghazi, Libya.

Patients and Methods

Three hundred patients attending the outpatient clinic and cardiology department at Benghazi Medical Center and National Cardiac Center between May 2020 and October 2020 were included in the study. All patients were managed according to the usual local institutional practice. They were included if they were 18 years or older and had AF on electrocardiogram (ECG) or Holter recording during the qualifying admission or consultation. Patients with an only atrial flutter on their ECGs were excluded. Patients' data were obtained through medical records using a chart review. Data collection included age, gender, disease duration at the time of presentation, clinical characteristics, and use of anticoagulation based on CHADs2VaSc2 score.

Patients were categorized into a clinical type of AF, based on the physician's perception of the AF at the time of presentation.

The first detected episode is defined as AF that diagnosed for the first time by a physician, in which it is important to distinguish whether it is symptomatic or self-limiting, recognizing that there may be uncertainty about the duration of the episode and previous undetected episodes.

Recurrent AF is the AF that terminates spontaneously and lasts 7 days (mostly, 24 h).

Permanent atrial fibrillation

Is the AF that has been present for a long time, cardioversion has not been indicated, or one or several attempts have failed to restore reliable sinus rhythm.^[3],[4],[5]

Ethical consideration

The study was conducted according to the declaration of Helsinki 1975. The study was approved by the ethical committee of the Benghazi Medical Center. All the information was kept confidential, and no individual identifiers were collected.

Statistical analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 17.0 (SPSS Inc. Chicago, IL, USA). Descriptive statistics of the different variables were presented either as frequencies and percentages or as means ± standard deviation. Frequency tables were analyzed using the Chi-square test, and P values were used to assess the significance of the correlation between the categorical variables. In all cases, P < 0.05 was considered statistically significant.

Results

Three hundred patients with an established diagnosis of AF were enrolled in this study, including 210 (70%) females and 90 (30%) males. The mean age at the time of diagnosis was 49.5 ± 21.5 years, with an age range of 29–79 years. A total of 139 (46.3%) were diagnosed as permanent AF, 132 (44%) paroxysmal AF, while new-onset AF was diagnosed in 29 (9.7%) of the studied patients [Table 1].

Table 1: Demographic, clinical characteristics and antithrombotic practice according to the clinical classification of AF in the studied population

Click here to view

The three clinical categories of AF were enrolled under the care of both cardiologists and internal medicine physicians, but permanent AF patients were more often enrolled under the care of a cardiologist. Patients with permanent AF were older compared with those with paroxysmal subtype (61.8 ± 9 and 50.1 ± 12, respectively), with significant female predominance (P = 0.03), and more often had coronary artery disease (CAD), valvular heart disease, and a previous stroke/TIA (P = 0.01, P = 0.124, and P = 0.002, respectively).

Diabetes was by far the most prevalent associated medical condition, followed by hypertension and hyperlipidemia. CAD was diagnosed among 122 (40.67%) patients. Of permanent AF patients, 28 patients (20.1%) previously suffered from a stroke, mostly TIA, in contrast to 14 patients (10.6%) of the other AF patients. Regarding anticoagulation, 74 patients (24.67%) were on T. warfarin, DOACs were prescribed for 39 patients (13%) most of them were of permanent AF subtype.

Discussion

Up to our knowledge, this is the first cross-sectional study from Benghazi-Libya; Most of the published data regarding the epidemiology and prognosis of AF arising from developed countries.^[9] The mean age at the diagnosis of patients in the present study (59.5 ± 11 years) is similar to most studies in Egyptian^[10] and sub-Saharan area, which reported younger age below 60 years.^{[11],[12],[13],[14]} Conversely, most studies from developed countries reported older age of AF patients at presentation.^{[9],[15],[16],[17],[18],[19]} In the current study, the majority of our AF patients (70%) were females, which is consistent with the findings of the Turkish AF (TRAF) cohort,^[9] this was against data reported from the Western healthcare systems, in which the prevalence of AF has been reported to be greater in men than women.^[20],[21] Although we do not have a clear explanation, it might be related to the high prevalence of obesity, metabolic syndrome, and cardiovascular diseases in Libyan women over the age of 40 as compared to the European.

Permanent AF was the most frequent type among our study population (46.3%) followed by paroxysmal AF (44%), while first AF was reported in 9.7%, this was comparable to other studies by Brand et al.^[22] and Nieuwlaat et al.^[15] (11% and 10%, respectively). In contrast, in population-based studies, the prevalence of lone AF was lower, between 2.7%^[23] and 7.6%.^[24]

In the current study, hypertension was reported in 55% of the study patients, similar results were reported by TRAF^[9] and ATRIA studies.^[25] Diabetes was the most prevalent cardiovascular risk factor (88%). While CAD and cardiac failure with low EF <45% were reported in 40.6% and 42% of patients, respectively, a higher prevalence of heart failure was reported in other studies.^{[9],[12],[16]} Sixty-five patients (18.6%) of our patients have valvular heart disease. TRAF survey reported similar results (16.75%), compared with the data obtained previously in Geneva, Switzerland^[21] and some other developed countries^[11],[26] higher prevalence (25.6%) was reported.

Oral anticoagulation (OAC) was prescribed in 37.7% of patients only, and adherence to current guidelines was poor in AF patients with CHADS2VAsC2 scores of 2. The rate of OAC prescription was lower to what has been observed in Europe: In the Euro Heart Survey,^[15] which reported that OAC was prescribed to 67% of the eligible patients, and in Geneva,^[21] OAC was prescribed in 88% of AF patients with moderate or high stroke risk. Reasons for the low prescription rate of OAC difficulties in evaluating adequate anticoagulation using the INR, relative contraindications (e.g. uncontrolled hypertension), and a significant number of patients who are under general physician follow-up. Similar observations have been made in Zimbabwe and Cameroon.^[26],[27] Only 38% of AF urban patients and only 19% of rural AF patients received OAC, despite a high-risk clinical profile.

Conclusion

Our AF patients were characterized by an unfavorable cardiovascular risk profile. We recognize the lower rate of OAC prescription, which needs further evaluation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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