Abstract:

Introduction: Atrial fibrillation (AF) and heart failure (HF) are two comorbid conditions that are discordant. The prevalence of AF is reported to increase with the advance in HF severity. Several prognostic factors for a patient with heart failure at Bugando Medical Centre (BMC) have been elaborated. Nonetheless, there was a paucity of information on the prevalence and outcomes of AF among adults with HF. This study aimed to determine the prevalence and outcomes of AF among adults with HF attending the outpatient clinic at BMC.

Methods: It was a hospital-based cross-sectional study with a follow-up component conducted from October 2019 to May 2020. A structured questionnaire was used to capture social demographic and clinical information. Adults with HF based on Framingham criteria underwent resting 12-lead ECG for the assessment of AF. All the study participants were followed up for three months, monitoring them for hospital admission, and mortality. Data were analyzed using STATA software version 13.

Results: A total of 403 adults with HF who were attending a clinic at Bugando hospital were recruited, female were 234 (58.1%) with a median age of 51-73[IQR 63] years. The prevalence of AF was 70/403 (17.4%), most was Non-valvular AF 64/70 (91.43%). Alcohol consumption and lower blood pressure below 130mmhg were found to be significant predictors for AF. The rate control strategy was administered in 53/70 (75.7%) with beta-blocker and digoxin commonly prescribed, and all participants had CHA2DS2VASC score ≥2. However, 37/70(52.9%) participants were on anticoagulant drugs, 5/70(7.1%) on Rivaroxaban, 32/70(45.7%) on warfarin, and the remaining 33/70(47.1%) were not on any anticoagulation. Among participants who ware on warfarin, only 9/32 (28.1%) achieved therapeutic INR. At three months of follow up 182/333(54.7%) patients with HF alone were hospitalized vs. 49/70(70%) with HF/AF (p-value 0.018) and death occurred 89/333 (26.7%) in HF alone vs. 31(44.3%) in those with HF/AF (p-value <0.003). AF was the only predictor of three-month mortality (p-value 0.015).

Conclusion: Atrial fibrillation is a prevalent problem in adults with heart failure attending the outpatient clinic at BMC, with a high rate of three-month hospital admissions and mortality. Utilization of alcohol and lower blood pressure less than 130mmhg were the main predictor for AF.

Recommendation: These results highlight the need to frequently screen for atrial fibrillation in heart failure patients to allow for initiation of appropriate management.