000			06389nam a22003977a 4500
001			CUHAS/MMED/6000242/T/16
003			CUHAS/MMED/6000242/T/16
005			20240422145452.0
008			210819b |||||||| |||| 00| 0 eng d
028			_bWurzburg Road 35, BMC Premises, Post Code: 33102:
028			_b P. O Box 1464, Mwanza – Tanzania:
028			_bPhone: +255 28 298 3384:
028			_bFax: +255 28 298 3386:
028			_bEmail: vc@bugando.ac.tz :
028			_bWebsite: www.bugando.ac.tz
035			_aCUHAS/MMED/6000242/T/16
040			_bEnglish _cddc
041			_aEnglish
100			_a Anikazi, Alphonce. Emmanuel _d[Male] _922446 _eCUHAS/MMED/6000242/T/16
210			_aAbbreviations _b AIDS Acquired Immunodeficiency Syndrome AF Atrial Fibrillation ACE Angiotensin-Converting enzyme ARBs Angiotensin Receptor Blockers AVNRT Atrioventricular nodal reentrant tachycardia BMC Bugando Medical Centre BMI Body Mass Index CAD Coronary Artery Disease CVD Cardiovascular Disease ESC European Society of Cardiology ECG Electrocardiography GDP Gross Domestic Product IHD Ischemic Heart Disease HF Heart Failure HFpEF Heart Failure with Preserved Ejection Fraction HFrEF Heart Failure with Reduced Ejection Fraction HTN Hypertension MNH Muhimbili National Hospital NYHA New York Heart Association MOPD Medical Outpatient Department RHD Rheumatic Heart Disease SSA Sub Saharan Africa PI Principal Investigator vAF Valvular Atrial Fibrillation nvAF Non valvular Atrial Fibrillation HF/AF Heart failure/Atrial fibrillation V-HeFT Vasodilator Heart failure trial study group VKA Vitamin K antagonist Anticoagulants NOAC Non Vitamin K Antagonist Anticoagulants CHA2DS2-VASc Congestive Heart failure, hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65–74, and Sex (female)
222			_aOperational Definitions _bAtrial Fibrillation It is defined according to the European Society of Cardiology’s “Guideline for the Management of Atrial Fibrillation (2016)” as electrocardiogram findings, which are "irregular RR intervals and no discernible, distinct P waves."
222			_aOperational Definitions _bHeart Failure Defined by the Framingham Criteria, which requires the simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria plus NYHA functional class III/IV. The Framingham criteria are included in the appendix
222			_aOperational Definitions _bObesity It is defined by Body Mass Index (BMI) as recommended by the World Health Organization. Underweight BMI of less than 18.5kg/m2, normal weight BMI of 18.5-24.4kg/m2, overweight BMI of 25-29.9kg/m2, and Obesity is a BMI ≥ 30kg/m2.
222			_aOperational Definitions _bRate control
222			_aOperational Definitions _b Anemia It is defined according to the European Society of Cardiology’s “Guideline for the Management of Atrial Fibrillation (2016)” heart rate less than 110 beats/minute at rest. It is according to the WHO criteria (Gibson 1993) hemoglobin less than 13g/dl and 12g/dl for males and females, respectively.
222			_aOperational Definitions _bPer capital Income It is according to 2019 World Bank Criteria whereby annual GDP per Capital in Tanzania is 930$.
245			_aPrevalence, Treatment Partners and Outcomes of Atrial Fibrillation Among Adults with Heart Failure at Bugando Medical Centre Mwanza Tanzania.
260			_aMwanza, Tanzania: _b Catholic University of Health and Allied Sciences [CUHAS - Bugando] : _c2020
300			_axiv; 104 Pages
300			_aIncludes References and Appendices
520			_aAbstract: 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.
600			_x Internal Medicine _915587
700			_a Peck, Robert _919791
700			_aKalokola, Fredrick _920958
942			_2ddc _cMP
999			_c18245 _d18245