Irene MULUH MAGHA3*, Anastase DZUDIE1,2,3 , Yacouba MAPOURE1 , Jules NDJEBERT4 , Archange NZALI3 , Armel NDJOMO1, Felicite KAMDEM1, Henri NGOTE1 , Marie-Solange NDOM1 , MOULIOM1 , Martin ABANDA3 , Calypse NGWASWIRI3 , Simeon Pierre CHOUKEM1 , Samuel KINGUE2,3
1Service of Internal Medicine and Subspecialty, Douala General Hospital, Cameroon ; 2Faculty of Medicine and Biomedical Sciences, University of Yaounde 1 ; 3Clinical Research Education Networking and Consultancy (CRENC) Douala, Cameroon ; 4Douala Cardiovascular Centre
CaHReF 2018, Yaoundé Congres hall, 08 – 11 January 2019 , OERF036
Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. There is a five-fold increased risk of ischemic stroke in patients with AF. It has been established that the advent of DOACs presents benefits over VKAs, but in Africa including Cameroon data are scarce on the contemporary antithrombotic therapyinAF
Objectif: Describe the contemporary profile, evaluate CHA2DS2VASc and HAS-BLED scores and describe treatment strategies for prevention of ischemic stroke of patients with AF inDouala.
Methodology: This was a hospital-based, cross-sectional study conducted over a period of 4 months amongst patients with a confirmed diagnosis of AF in six different cardiology units in Douala. Consenting patients aged? 21 years with pre-existing or de novo atrial fibrillation were recruited. Data were collected using well-structured questionnaires and complemented by reviewing the patient's records. Data were entered into Epi info version 7.2 and analysed using SPSS version 23. Univariate analysis was carried out using Chi-square or Fisher exact test for categorical variables where appropriate (level of significance was set at P <0.05).
Results: 101 participants recruited, 62(61.4%) were females. The mean age was 69.81 ±12.2 years. Heart failure was the most common comorbidity (N=66;65.3%) and 12.9% (N=13) had suffered an ischemic stroke. The median (IQR) CHA2DS2VASc score was 3 (2-4) and the median (IQR) HAS-BLED score was 2 (1-3). Majority of participants were receiving antithrombotic therapy [97% (N=98)]. Antiplatelets accounted for 24.8%(N=25). Oral anticoagulants were used in 74.3%(N=75) of participants, with VKAs accounting for 61.4%(N=62) and DOACs accounting for 12.9%(N=13). For participants receiving VKAs, 24% (N=12) were on therapeutic goal. Cost of drug was the highest influence of drug choice.
Conclusion/Recommandation: Patients with AF in Cameroon had a high risk of embolism but also a high bleeding risk. Three-quarter of patients with AF received specific antithrombotic treatment, 60% of them receiving VKAs. Only 1in 4 patients on VKAs were on therapeutic goal. While further research are still awaited to clarify the real life safety and effectiveness of DOACs in our environment, current preventive strategies of ischemic stroke should include an improvement of access to these medications.
Key Words:Atrial fibrillation CHA2DS2VASC HASBLEDAnticoagulants