Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study.
Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study.
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DOI：
10.1136/bmjopen-2021-058200
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发表时间：
2022-01-19
期刊：
影响因子：
2.9
通讯作者：
Kalokola F
中科院分区：
文献类型：
--
作者：
Chen Y;Alphonce E;Mujuni E;Kisigo GA;Kingery JR;Makubi A;Peck RN;Kalokola F
近年来，心力衰竭（HF）和其他相关心血管疾病的患病率和死亡率在撒哈拉以南非洲（SSA）翻了一番。高收入国家的研究表明，HF并发房颤（AF）与死亡率增加有关。我们的目的是确定SSA心力衰竭患者中AF的发生率和临床结局。一项前瞻性队列研究，使用2018年10月至2020年5月期间收集的数据。坦桑尼亚姆万扎一家三级医院的门诊。303例根据欧洲心脏病学会指南（2016）定义的HF成人受试者（年龄≥18岁）和100例仅根据临床标准定义的HF成人受试者入组本研究。排除了预后<3个月（即晚期实体瘤、晚期血液恶性肿瘤）的合并症患者。对参与者进行房颤筛查，并获得他们的病史、体格检查和社会人口学信息。多变量logistic回归模型用于检查与AF发病率相关的因素。采用考克斯回归模型分析3个月死亡率及其相关危险因素。我们招募了403名HF受试者（平均年龄60±19岁，234名（58%）女性）。房颤患病率为17%。在多变量模型中，与AF相关的因素是低收入、饮酒和HF持续时间较长。在3个月的随访结束时，403名参与者中有120名（30%）死亡，其中包括44%（31/70）的AF患者。ECG显示的较高心率、更严重的纽约心脏协会HF分级、农村居住和贫血与死亡率显著相关。在坦桑尼亚，AF是一种常见的未被诊断的疾病，与HF门诊患者的显著死亡率相关（HR 1.749，95% CI 1.162 - 2.633，p=0.007）。我们的研究结果还将心动过速（>110 bpm，HR 1.879，95%CI 1.508至2.340，p<0.001）确定为HF患者不良结局的一种易于测量、高影响的体格检查结果。
In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA. A prospective cohort study using data collected between October 2018 and May 2020. Outpatient clinic at a tertiary hospital in Mwanza, Tanzania. 303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded. Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors. We enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality. AF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p<0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.
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