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The prevalence, management, and thirty-day outcomes of symptomatic atrial fibrillation in a Tanzanian emergency department.

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Date
2021-12
Authors
Oyediran, Isaac O
Prattipati, Sainikitha
Sakita, Francis M
Kweka, Godfrey L
Tarimo, Tumsifu G
Peterson, Timothy
Loring, Zak
Limkakeng, Alexander T
Bloomfield, Gerald S
Hertz, Julian T
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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.
Type
Journal article
Subject
Atrial fibrillation
Emergency Centre
Sub-Saharan Africa
Tanzania
Permalink
https://hdl.handle.net/10161/24040
Published Version (Please cite this version)
10.1016/j.afjem.2021.07.002
Publication 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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Scholars@Duke

Bloomfield

Gerald Bloomfield

Associate Professor of Medicine
Hertz

Julian T Hertz

Assistant Professor of Surgery
Limkakeng

Alexander Tan Limkakeng Jr.

Professor of Surgery
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 Chief of Research for the Duke Division of Emergency Medicine, I also work with researchers from many fields spanning global health, innovation, clinical trials, basic discovery, and translational research. The
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