|Year : 2021 | Volume
| 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|
Dr. Khaled D Alsaeiti
Department of Internal, Medicine, Libyan International Medical University, Benghazi
Source of Support: None, Conflict of Interest: None
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., 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., 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. 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. 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. Several population-based studies provided information on the incidence, prevalence, and outcome of AF in the general population.,, 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.,,
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.
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. The mean age at the diagnosis of patients in the present study (59.5 ± 11 years) is similar to most studies in Egyptian and sub-Saharan area, which reported younger age below 60 years.,,, Conversely, most studies from developed countries reported older age of AF patients at presentation.,,,,, 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, 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., 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. and Nieuwlaat et al. (11% and 10%, respectively). In contrast, in population-based studies, the prevalence of lone AF was lower, between 2.7% and 7.6%.
In the current study, hypertension was reported in 55% of the study patients, similar results were reported by TRAF and ATRIA studies. 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.,, 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 and some other developed countries, 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, which reported that OAC was prescribed to 67% of the eligible patients, and in Geneva, 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., 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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates. Am J Cardiol 1998;82:2N-9N.
Vidaillet H, Granada JF, Chyou PH, Maassen K, Ortiz M, Pulido JN, et al
. A population-based study of mortality among patients with atrial fibrillation or flutter. Am J Cardiol 2002;113:365-70.
Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: Epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 2003;91:2D-8D.
Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al.
Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: The Framingham Heart Study. Circulation 2003;107:2920-5.
Stewart S, Murphy NF, Walker A, McGuire A, McMurray JJ. Cost of an emerging epidemic: An economic analysis of atrial fibrillation in the UK. Heart 2004;90:286-92.
Hackam DG, Spence JD. Combining multiple approaches for the secondary prevention of vascular events after stroke: A quantitative modeling study. Stroke 2007;38:1881-5.
da Costa Dias FL, Ferreira Lisboa da Silva RM, de Moraes EN, Caramelli P. Cholinesterase inhibitors modulate autonomic function in patients with Alzheimerxs disease and mixed dementia. Curr Alzheimer Res 2013;10:476-81.
Wattigney WA, Mensah GA, Croft JB. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: Implications for primary prevention. Circulation 2003;108:711-6.
Yavuz B, Ata N, Oto E, Katircioglu-Öztürk D, Aytemir K, Evranos B, et al.
Demographics, treatment and outcomes of atrial fibrillation in a developing country: The population-based TuRkish Atrial Fibrillation (TRAF) cohort. Europace 2017;19:734-40.
Hassanein M, Abdelhamid M, Ibrahim B, Elshazly A, Aboleineen MW, Sobhy H, et al.
Clinical characteristics and management of hospitalized and ambulatory patients with heart failure–Results from ESC heart failure long-term registry–Egyptian cohort. ESC Heart Failure 2015;2:159-67.
Sliwa K, Carrington MJ, Klug E, Opie L, Lee G, Ball J, et al.
Predisposing factors and incidence of newly diagnosed atrial fibrillation in an urban African community: Insights from the Heart of Soweto Study. Heart 2010;96:1878-82.
Coulibaly I, Anzouan-Kacou J, Kouao Konin C, Kouadio S, Abouo-N'Dori RJ. Atrial fibrillation: epidemiological data from the Cardiology Institute in Abidjan, Côte d'Ivoire. Med Trop . 2010;70:371-4.
Hamadou B, Kamdem M, Nadè C, Dzudie A, Monkam Y, Kingue SJOALJ. Epidemiologic aspects of atrial fibrillation in a tertiary hospital in a sub-Saharan Africa setting. Open Access Libr J 2017;4:1-8.
Mbaye A, Pessinaba S, Bodian M, Mouhamadou BN, Mbaye F, Kane A, et al.
Atrial fibrillation, frequency, etiologic factors, evolution and treatment in a cardiology department in Dakar, Senegal. Pan Afr Med J 2010;6:16.
Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW, et al.
Atrial fibrillation management: A prospective survey in ESC member countries: The Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005;26:2422-34.
J Petrella R, Sauriol L. Demographic characteristics and patterns of medication in atrial fibrillation patients in South West Ontario: Insights from a large primary care database. J Atr Fibrillation 2012;4:436.
Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med 1995;98:476-84.
Ceresne L, Upshur RE. Atrial fibrillation in a primary care practice: Prevalence and management. BMC Fam Pract 2002;3:11.
Kerr CR, Humphries KH, Talajic M, Klein GJ, Connolly SJ, Green M, et al.
Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: Results from the Canadian Registry of Atrial Fibrillation. Am Heart J 2005;149:489-96.
Association Dwtscot EH, Surgery EbtEAfC-T, Members ATF, Camm AJ, Kirchhof P, Lip GY, et al.
Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-429.
Meiltz A, Zimmermann M, Urban P, Bloch A, Association of Cardiologists of the Canton of Geneva. Atrial fibrillation management by practice cardiologists: A prospective survey on the adherence to guidelines in the real world. Europace 2008;10:674-80.
Brand FN, Abbott RD, Kannel WB, Wolf PA. Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study. JAMA 1985;254:3449-53.
Kopecky SL, Gersh BJ, McGoon MD, Whisnant JP, Holmes DR Jr., Ilstrup DM, et al.
The natural history of lone atrial fibrillation. N Eng J Med 1987;317):669-74.
Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol 1994;74:236-41.
Singer DE, Chang Y, Borowsky LH, Fang MC, Pomernacki NK, Udaltsova N, et al
. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: The ATRIA study stroke risk score. J Am Heart Assoc 2013;2:e000250.
Ntep-Gweth M, Zimmermann M, Meiltz A, Kingue S, Ndobo P, Urban P, et al.
Atrial fibrillation in Africa: Clinical characteristics, prognosis, and adherence to guidelines in Cameroon. Europace 2010;12:482-7.
Bhagat K, Tisocki K. Prescribing patterns for the use of antithrombotics in the management of atrial fibrillation in Zimbabwe. Cent Afr J Med 1999;45:287-90.