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Abstract
ABSTRACT
Introduction. Atrial fibrillation (AF) is the commonest heart rhythm disturbance. In Cameroon, its prevalence is about 7-8% in hospital based studies. AF is associated with symptoms which affect the functional status of patients. Functional class of AF patients rated by the (European Heart Rhythm Association) EHRA scale has not been studied in Cameroon. We aimed to determine the functional status of AF patients according to the EHRA classification in a hospital setting in Yaounde. Methods. It was a cross-sectional analytic study. We recruited 61 patients. Informed consent was obtained from all participants. Proportions were calculated to display the frequency of various EHRA classes and to stratify them into good and poor functional class groups. Univariate and multivariate analyses were performed to determine the factors associated with poor functional status. A result was considered statistically significant if the 95% confidence intervals did not include 1 or if the p-value was <0.05. Results. Our mean age was 71 years with 62% of our patients aged between 60-80 years. The most common risk factor of AF were hypertension (63%), and heart failure (41%). Majority (40%) had HFpEF. Beta-blockers were the most used rate control strategy (50%) and 72% patients had optimal heart rate. More than half our AF patients (54%) had poor functional class. Diastolic dysfunction was a significant predictor of poor functional status (OR=5; 95%CI: 1.04-25; P=0.03). Conclusion. Poor functional status was frequent in our population of AF patients despite most of them having good systolic function. Diastolic dysfunction has a negative impact on functional class of AF patients. Treating diastolic dysfunction may be an important long term strategy in improving functional status of AF patients.
RÉSUMÉ
Introduction. La fibrillation auriculaire (FA) est le trouble du rythme cardiaque le plus fréquent. Au Cameroun, sa prévalence est d'environ 7 à 8% en milieu hospitalier. La FA est associée à des symptômes qui affectent l'état fonctionnel des patients. L’évaluation du statut fonctionnel des patients selon la classification EHRA (European Heart Rhythm Association) n'a pas encore été étudiée au Cameroun. Notre objectif était d’évaluer l'état fonctionnel des patients atteints de FA selon la classification EHRA en milieu hospitalier à Yaoundé. Méthodologie. Il s’est agi d’une étude transversale analytique. Nous avons recruté 61 patients atteints de FA. Un consentement éclairé a été obtenu de tous les participants. Les proportions ont été calculées pour afficher la fréquence des diverses classes EHRA ; les classes fonctionnelles ont été stratifié en deux groupes : bon statut fonctionnel pour les classes I et II de ERHA et mauvais statut fonctionnel pour les classe III et IV de ERHA. Un résultat était considéré comme statistiquement significatif si les intervalles de confiance à 95% n'incluaient pas 1 et la valeur p était <0,05. Résultats. L’âge moyen était de 71 ans et 62% de nos patients étaient âgés de 60 à 80 ans. Les facteurs de risque de FA les plus courants étaient l'hypertension (63%) et l'insuffisance cardiaque (41%). La majorité (40%) avait une insuffisance cardiaque à fraction d’éjection préservée. La stratégie de contrôle de la fréquence était la plus utilisée et faisait appel majoritairement aux bétabloquants (50%) ; la fréquence cardiaque optimale chez 72% des patients. 54% de nos patients avaient un mauvais statut fonctionnel. La dysfonction diastolique était un prédicteur significatif d'un mauvais statut fonctionnel (OR = 5; IC à 95%: 1,04-25; P = 0,03).Conclusion. La majorité de notre population de patients atteints de FA présente un mauvais statut fonctionnel, bien que la plupart d'entre eux aient une bonne fonction systolique. La dysfonction diastolique a un impact négatif sur la classe fonctionnelle des patients atteints de FA.
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References
- Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation [Internet]. 2006 Aug 15 [cited 2019 Feb 2];114(7):e257-354. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16908781
- Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, Age Distribution, and Gender of Patients With Atrial Fibrillation. Arch Intern Med [Internet]. 1995 Mar 13 [cited 2019 Feb 2];155(5):469. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.1995.00430050045005
- Novaro GM, Asher CR, Bhatt DL, Moliterno DJ, Harrington RA, Lincoff AM, et al. Meta-Analysis Comparing Reported Frequency of Atrial Fibrillation After Acute Coronary Syndromes in Asians Versus Whites. Am J Cardiol [Internet]. 2008 Feb 15 [cited 2019 Feb 2];101(4):506–9. Available from: https://www.sciencedirect.com/science/article/pii/S0002914907020425
- Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby J V., et al. Prevalence of Diagnosed Atrial Fibrillation in Adults. JAMA [Internet]. 2001 May 9 [cited 2019 Feb 2];285(18):2370. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.285.18.2370
- 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 [Internet]. 1994 Aug 1 [cited 2019 Feb 2];74(3):236–41. Available from: https://www.sciencedirect.com/science/article/pii/0002914994903638
- Amin A, Houmsse A, Ishola A, Tyler J, Houmsse M. The current approach of atrial fibrillation management. Avicenna J Med [Internet]. 2016 [cited 2019 Feb 2];6(1):8–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26955600
- B.S. S, L.M. N. Atrial fibrillation in sub-saharan Africa: Epidemiology, unmet needs, and treatment options. Int J Gen Med [Internet]. 2015;8:231–42. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L605741406%5Cnhttp://dx.doi.org/10.2147/IJGM.S84537%5Cnhttp://sfx.library.uu.nl/utrecht?sid=EMBASE&issn=11787074&id=doi:10.2147%2FIJGM.S84537&atitle=Atrial+fibrillation+in+sub-sahara
- Coulibaly I, Anzouan-Kacou JB, Konin KC, Kouadio SC, Abouo-N’Dori R. [Atrial fibrillation: epidemiological data from the Cardiology Institute in Abidjan, Côte d’Ivoire]. Med Trop (Mars) [Internet]. 2010 Aug [cited 2019 Feb 2];70(4):371–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22368936
- Alassane M, Souleymane P, Malick B, Bamba NM, Fatou M, Adama K, Valentin YN, Maboury D AK. La fibrillation atriale , fréquence, facteurs étiologiques , évolution et traitement dans un service de cardiologie de Dakar , Sénégal. Pan Afr Med J. 2010;6(16):1–11.
- Kamdem F, Hamadou B, Kamdem M, Nganou CN, Dzudie A, Monkam Y, et al. Epidemiologic Aspects of Atrial Fibrillation in a Tertiary Hospital in a Sub-Saharan Africa Setting. OALib [Internet]. 2017;04(02):1–8. Available from: http://www.oalib.com/paper/pdf/5281913
- Boombhi J, Menanga A, Mfeukeu-Kuaté L, Kungni E, Mounpou B, Kingué S. Caractéristiques Cliniques et Thérapeutiques de la Fibrillation Atriale en Milieu Hospitalier à Yaoundé , Cameroun. 2019;(2):23–6.
- Chugh SS, Havmoeller R, Narayanan K, Kim Y, Jr JHM, Zheng Z. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47.
- Khand AU, Rankin AC, Martin W, Taylor J, Gemmell I, Cleland JGF. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? J Am Coll Cardiol [Internet]. 2003 Dec 3 [cited 2019 Feb 2];42(11):1944–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14662257
- Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care [Internet]. 1996 Mar [cited 2019 Mar 24];34(3):220–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8628042
- Thrall G, Lane D, Carroll D, Lip GYH. Quality of Life in Patients with Atrial Fibrillation: A Systematic Review. Am J Med [Internet]. 2006 May [cited 2019 Jan 6];119(5):448.e1-448.e19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16651058
- Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–78.
- Kirchhof P, Ammentorp B, Darius H, De Caterina R, Le Heuzey J-Y, Schilling RJ, et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace [Internet]. 2014 Jan [cited 2019 Jan 19];16(1):6–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24084680
- Dufaitre G, Meuleman C, Logeart D. Evaluation échocardiographique des pressions de remplissage ventriculaire gauche. In: Cohen A, Guéret P, editors. Manuel d’échocardiographie clinique. Paris: Médecine Sciences Lavoisier; 2012.
- 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(4):482–7.
- National Institute of Statistics. 2Nd Survey on the Monitoring of Public Expenditures and the Level of Recipients’ Satisfaction in the Education and Health Sectors in Cameroon (Pets2) [Internet]. 2010. Available from: www.statistics-cameroon.org/.../pets/2/Rapport_principal_Sante_anglais.pdf
- Gutierrez C, Blanchard DG. Diastolic heart failure: Challenges of diagnosis and treatment. Am Fam Physician. 2004;69(11):2609–16.
References
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation [Internet]. 2006 Aug 15 [cited 2019 Feb 2];114(7):e257-354. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16908781
Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, Age Distribution, and Gender of Patients With Atrial Fibrillation. Arch Intern Med [Internet]. 1995 Mar 13 [cited 2019 Feb 2];155(5):469. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.1995.00430050045005
Novaro GM, Asher CR, Bhatt DL, Moliterno DJ, Harrington RA, Lincoff AM, et al. Meta-Analysis Comparing Reported Frequency of Atrial Fibrillation After Acute Coronary Syndromes in Asians Versus Whites. Am J Cardiol [Internet]. 2008 Feb 15 [cited 2019 Feb 2];101(4):506–9. Available from: https://www.sciencedirect.com/science/article/pii/S0002914907020425
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby J V., et al. Prevalence of Diagnosed Atrial Fibrillation in Adults. JAMA [Internet]. 2001 May 9 [cited 2019 Feb 2];285(18):2370. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.285.18.2370
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 [Internet]. 1994 Aug 1 [cited 2019 Feb 2];74(3):236–41. Available from: https://www.sciencedirect.com/science/article/pii/0002914994903638
Amin A, Houmsse A, Ishola A, Tyler J, Houmsse M. The current approach of atrial fibrillation management. Avicenna J Med [Internet]. 2016 [cited 2019 Feb 2];6(1):8–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26955600
B.S. S, L.M. N. Atrial fibrillation in sub-saharan Africa: Epidemiology, unmet needs, and treatment options. Int J Gen Med [Internet]. 2015;8:231–42. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L605741406%5Cnhttp://dx.doi.org/10.2147/IJGM.S84537%5Cnhttp://sfx.library.uu.nl/utrecht?sid=EMBASE&issn=11787074&id=doi:10.2147%2FIJGM.S84537&atitle=Atrial+fibrillation+in+sub-sahara
Coulibaly I, Anzouan-Kacou JB, Konin KC, Kouadio SC, Abouo-N’Dori R. [Atrial fibrillation: epidemiological data from the Cardiology Institute in Abidjan, Côte d’Ivoire]. Med Trop (Mars) [Internet]. 2010 Aug [cited 2019 Feb 2];70(4):371–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22368936
Alassane M, Souleymane P, Malick B, Bamba NM, Fatou M, Adama K, Valentin YN, Maboury D AK. La fibrillation atriale , fréquence, facteurs étiologiques , évolution et traitement dans un service de cardiologie de Dakar , Sénégal. Pan Afr Med J. 2010;6(16):1–11.
Kamdem F, Hamadou B, Kamdem M, Nganou CN, Dzudie A, Monkam Y, et al. Epidemiologic Aspects of Atrial Fibrillation in a Tertiary Hospital in a Sub-Saharan Africa Setting. OALib [Internet]. 2017;04(02):1–8. Available from: http://www.oalib.com/paper/pdf/5281913
Boombhi J, Menanga A, Mfeukeu-Kuaté L, Kungni E, Mounpou B, Kingué S. Caractéristiques Cliniques et Thérapeutiques de la Fibrillation Atriale en Milieu Hospitalier à Yaoundé , Cameroun. 2019;(2):23–6.
Chugh SS, Havmoeller R, Narayanan K, Kim Y, Jr JHM, Zheng Z. Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47.
Khand AU, Rankin AC, Martin W, Taylor J, Gemmell I, Cleland JGF. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? J Am Coll Cardiol [Internet]. 2003 Dec 3 [cited 2019 Feb 2];42(11):1944–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14662257
Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care [Internet]. 1996 Mar [cited 2019 Mar 24];34(3):220–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8628042
Thrall G, Lane D, Carroll D, Lip GYH. Quality of Life in Patients with Atrial Fibrillation: A Systematic Review. Am J Med [Internet]. 2006 May [cited 2019 Jan 6];119(5):448.e1-448.e19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16651058
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–78.
Kirchhof P, Ammentorp B, Darius H, De Caterina R, Le Heuzey J-Y, Schilling RJ, et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace [Internet]. 2014 Jan [cited 2019 Jan 19];16(1):6–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24084680
Dufaitre G, Meuleman C, Logeart D. Evaluation échocardiographique des pressions de remplissage ventriculaire gauche. In: Cohen A, Guéret P, editors. Manuel d’échocardiographie clinique. Paris: Médecine Sciences Lavoisier; 2012.
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(4):482–7.
National Institute of Statistics. 2Nd Survey on the Monitoring of Public Expenditures and the Level of Recipients’ Satisfaction in the Education and Health Sectors in Cameroon (Pets2) [Internet]. 2010. Available from: www.statistics-cameroon.org/.../pets/2/Rapport_principal_Sante_anglais.pdf
Gutierrez C, Blanchard DG. Diastolic heart failure: Challenges of diagnosis and treatment. Am Fam Physician. 2004;69(11):2609–16.