The prevalence, management, and thirty-day outcomes of symptomatic atrial fibrillation in a Tanzanian emergency department.
Abstract
<h4>Introduction</h4>Data describing atrial fibrillation (AF) care in emergency centres
(ECs) in sub-Saharan Africa is lacking. We sought to describe the prevalence and outcomes
of AF in a Tanzanian EC.<h4>Methods</h4>In a prospective, observational study, adults
presenting with chest pain or shortness of breath to a Tanzanian EC were enrolled
from January through October 2019. Participants underwent electrocardiogram testing
which were reviewed by two independent physician judges to determine presence of AF.
Participants were asked about their medical history and medication use at enrollment,
and a follow-up questionnaire was administered via telephone thirty days later to
assess mortality, interim stroke, and medication use.<h4>Results</h4>Of 681 enrolled
patients, 53 (7.8%) had AF. The mean age of participants with AF was 68.1, with a
standard deviation (sd) of 21.1 years, and 23 of the 53 (43.4%) being male. On presentation,
none of the participants found to have AF reported a previous history of AF. The median
CHADS-VASC score among participants was 4 with an interquartile range (IQR) of 2-4.
No participants were taking an anticoagulant at baseline. On index presentation, 49
(92.5%) participants with AF were hospitalised with 52 (98.1%) participants completing
30-day follow-up. 18 (34%) participants died, and 5 (9.6%) suffered a stroke. Of the
surviving 31 participants with AF and a CHADS-VASC score ≥ 2, none were taking other
anti-coagulants at 30 days. Compared to participants without AF, participants with
AF were more likely to be hospitalised (OR 5.25, 95% CI 2.10-17.95, p < 0.001), more likely to die within thirty days (OR 1.93, 95% CI 1.03-3.50, <i>p</i> = 0.031), and more likely to suffer a stroke within thirty days (OR 5.91, 95% CI 1.76-17.28,
p < 0.001).<h4>Discussion</h4>AF is common in a Tanzanian EC, with thirty-day mortality
being high, but use of evidence-based therapies is rare. There is an opportunity to
improve AF care and outcomes in Tanzania.
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https://hdl.handle.net/10161/24040Published Version (Please cite this version)
10.1016/j.afjem.2021.07.002Publication Info
Oyediran, Isaac O; Prattipati, Sainikitha; Sakita, Francis M; Kweka, Godfrey L; Tarimo,
Tumsifu G; Peterson, Timothy; ... Hertz, Julian T (2021). The prevalence, management, and thirty-day outcomes of symptomatic atrial fibrillation
in a Tanzanian emergency department. African journal of emergency medicine : Revue africaine de la medecine d'urgence, 11(4). pp. 404-409. 10.1016/j.afjem.2021.07.002. Retrieved from https://hdl.handle.net/10161/24040.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Gerald Bloomfield
Associate Professor of Medicine
Julian T Hertz
Associate Professor of Emergency Medicine
Julian Hertz, MD, MSc, is an Associate Professor of Emergency Medicine & Global Health.
He graduated summa cum laude from Princeton University and attended medical school
at Duke University, where he received the Dean's Merit Scholarship and the Thomas
Jefferson Award for leadership. He completed his residency training in emergency medicine
at Vanderbilt University Medical Center and his fellowship in Global Health at Duke.Dr.
Hertz's primary interests include globa
Alexander Tan Limkakeng Jr.
Professor of Emergency Medicine
My personal research interest is finding new ways to diagnose acute coronary syndrome.
In particular, I am interested in novel biomarkers and precision medicine approaches
to this problem. I also have an interest in sepsis and empirical bioethics. As Vice
Chair of Clinical Research for the Duke University Department of Emergency Medicine,
I also work with researchers from many fields spanning global health, innovation,
clinical trials, basic discovery, and trans
Zak Loring
Assistant Professor of Medicine
I am a cardiac electrophysiologist specializing in the treatment of heart rhythm disorders
and management of cardiac implantable electronic devices (CIEDs). My research utilizes
signal processing of electrocardiographic data and novel analytic techniques to better
phenotype patients and identify those for whom interventional electrophysiology procedures
may be most beneficial. This includes predicting which patients with left bundle branch
block may benefit from early cardiac resynchronizatio
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