Sex Differences in the Modifiable Risk Factors for Atrial Fibrillation at Moi Teaching and Referral Hospital
Background: Evidence mainly from high-income countries has demonstrated sex related differences in the incidence, presentation and management of patients with non-valvular AF. Such evidence is scarce in sub-Saharan Africa, yet there is a rising prevalence of AF. This study aimed to determine sex differences in the distribution and treatment pattern for modifiable risk factors in Western Kenya.
Methods: The study included two phases. Phase 1 comprised of secondary data analysis from a case control study – Study of Genetics of Atrial Fibrillation in an African population. Phase 2 included retrospective analysis of medical records at the cardiac clinic in a large referral hospital in Kenya. We determined the distribution and treatment pattern for modifiable risk factors for AF using chi-square and fisher’s exact test.
Results: Hypertension is the most prevalent modifiable risk factor for AF in western Kenya. The prevalence among men and women was 65% and 76% respectively, but this difference was not significant. Three percent of men were obese compared to 24 % of women (p =0.013). Men were more likely to drink alcohol (p = 0.001) and have a history of smoking compared to women (p = <0.001). Among men, tetra choric correlation showed a very strong association between smoking and alcohol intake (correlation coefficient > 0.9), and hypertension and obesity/overweight (correlation coefficient >0.9). These correlations were weaker among women with a correlation coefficient of 0.40 and 0.38 respectively. Among the participants, only 21% had weight and height measurements recorded. Nutritional counselling was recorded for only 3% of those who had a BMI > 29.9. Similarly, less than 10% of those with a history of smoking or alcohol intake received counselling on cessation strategies.
Conclusion: Hypertension is the most common modifiable risk factor for AF in western Kenya. There are significant differences among men and women in the distribution of dyslipidemia, alcohol intake, smoking and obesity. These modifiable risk factors have strikingly low rates of interventions. Management of patients with AF should include both screening and interventions for modifiable risk factors. Packaging of intervention should consider sex-specific differences.
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Rights for Collection: Masters Theses