Prevalence and risk factors for atrial fibrillation in a semi-rural sub-Saharan African population: The hEart oF ethiopia: Focus on Atrial Fibrillation (TEFF-AF) Study

Bradley M Pitman; Sok-Hui Chew; Christopher X Wong; Amenah Jaghoori; Shinsuke Iwai; Ellen Lyrtzis; Matthew Lim; Rebekah R-X Chew; Andrew Chew; Prashanthan Sanders; Dennis H Lau

doi:10.1016/j.hroo.2022.09.008

Prevalence and risk factors for atrial fibrillation in a semi-rural sub-Saharan African population: The hEart oF ethiopia: Focus on Atrial Fibrillation (TEFF-AF) Study

Heart Rhythm O2. 2022 Dec 16;3(6Part B):839-846. doi: 10.1016/j.hroo.2022.09.008. eCollection 2022 Dec.

Authors

Bradley M Pitman¹, Sok-Hui Chew^{2

3}, Christopher X Wong¹, Amenah Jaghoori¹, Shinsuke Iwai¹, Ellen Lyrtzis¹, Matthew Lim¹, Rebekah R-X Chew^{2

3}, Andrew Chew^{2

3}, Prashanthan Sanders¹, Dennis H Lau¹

Affiliations

¹ Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
² Flinders Medical Centre, Flinders University, Adelaide, Australia.
³ Soddo Christian Hospital, Soddo, Ethiopia.

Abstract

Background: There is a scarcity of reported data on the prevalence of atrial fibrillation (AF) in sub-Saharan Africa.

Objectives: To undertake AF screening in semi-rural Ethiopia.

Methods: The TEFF-AF (The hEart oF Ethiopia: Focus on Atrial Fibrillation) study conducted AF screening using a single-lead electrocardiogram device (KardiaMobile) on willing community participants at the Soddo Christian Hospital, Ethiopia. Participants' clinical parameters and medical history were obtained to characterize their risk factor profile, including calculation of CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation) score.

Results: A total of 3000 Ethiopians (median 31 [interquartile range 25-41] years of age; 65% men) were screened. The participants were generally well educated, from the local region and with a low burden of cardiovascular risk factors. A total of 50 participants had a CHARGE-AF score (5-year AF risk) of ≥2%. AF was detected in 13 (0.43%) individuals (median 50 [interquartile range 36-60] years of age; n = 7 men). The prevalence among participants over 40 years of age was 1% (n = 9 of 930). AF prevalence was higher for older age groups, with ≥70 years of age reaching 6.67% (n = 3 of 45). Population prevalence was estimated to be 234 (95% confidence interval 7-460) per 10,000 persons for ≥60 years of age. Four (31%) of the 13 participants with AF had a CHA₂DS₂-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score of ≥2, and others likely had rheumatic valvular AF, but only 2 of the 13 participants with AF were on oral anticoagulation therapy.

Conclusion: In this semi-rural Ethiopian community of relatively younger participants, AF prevalence was found to be low but increased with increasing age. Mobile single-lead electrocardiogram technology can be used effectively for AF screening in low-resource settings.

Keywords: Atrial fibrillation; Ethiopia; Prevalence; Risk factors; Screening; Sub-Saharan Africa.