Epidemiological characteristics, management, and outcomes of atrial fibrillation in TUNISIA: Results from the National Tunisian Registry of Atrial Fibrillation (NATURE-AF)

Sana Ouali, Afef Ben Halima, Sonia Chabrak, Rafik Chettaoui, Manel Ben Halima, Abdeddayem Haggui, Salma Krichane, Larbi Noureddine, Sonia Marrakchi, Selma Charfeddine, Majed Hassine, Khaled Sayahi, Fehmi Abbes Mohamed, Wided Nasraoui, Hassen Ajmi, Mehdi Ben Miled, Zeynab Jebbari, Mohamed Ali Meghaieth, Emna Allouche, Rachid Mechmeche, Lilia Zakhama, Wissem Sdiri, Ali Ben Khalfallah, Anissa Gharbi, Sami Milouchi, Ali Neji, Saoussen Antit, Kais Battikh, Meriem Drissa, Samira Kaabachi, Tarek Najar, Rami Tlili, Iheb Chahbani, Hanene Charfeddine, Mbarek Mohamed Ben, Sami Braham, Faouzi Maatouk, Salem Abdesselem, Mokdad Ayari, Riadh Garbaa, Nabil Hamrouni, Dorra Mbarek, Hajer Rekik, Hamda Zaghdoudi, Wacef Ayadi, Feriel Baraket, Karim Ben Brahim, Mariem Ben Romdhane, Habib Bousadia, Wassim Brahim, Malek Mezri, Ali Guesmi, Taha Ounissi, Sofiene Kammoun, Wajih Smati, Samir Tlili, Karim Zoughi, Jawher Zemni, Mahmoud Cheikh Bouhlel, Sanaa Islem, Rym Jemli, Anissa Joulak, Khadija Mzoughi, Hela Naanea, Leila Hached, Moufid Hadrich, Mohamed Hmem, Slim Kacem, Ikram Kammoun, Rawdha Othmani, Amel Ouerghi, Syrine Abid, Ridha Ennouri, Sandrine Haidar, Sihem Heraiech, Monia Jammali, Mourad Jarrar, Leila Riahi, Basma Trimech, Med Ali Azaiez, Foued Azzouzi, Khaled Ben Jemaa, Oussema Ben Rejab, Rim Chrigui, Wejdene Wechtati, Essia Boughzela, Gouider Jridi, Leila Bezdah, Sondes Kraiem, Habiba Drissa, Soraya Ben Youssef, Wafa Fehri, Salem Kachboura, Habib Gamra, Samir Kammoun, Mohamed Sami Mourali, Faouzi Addad, Leila Abid, Sana Ouali, Afef Ben Halima, Sonia Chabrak, Rafik Chettaoui, Manel Ben Halima, Abdeddayem Haggui, Salma Krichane, Larbi Noureddine, Sonia Marrakchi, Selma Charfeddine, Majed Hassine, Khaled Sayahi, Fehmi Abbes Mohamed, Wided Nasraoui, Hassen Ajmi, Mehdi Ben Miled, Zeynab Jebbari, Mohamed Ali Meghaieth, Emna Allouche, Rachid Mechmeche, Lilia Zakhama, Wissem Sdiri, Ali Ben Khalfallah, Anissa Gharbi, Sami Milouchi, Ali Neji, Saoussen Antit, Kais Battikh, Meriem Drissa, Samira Kaabachi, Tarek Najar, Rami Tlili, Iheb Chahbani, Hanene Charfeddine, Mbarek Mohamed Ben, Sami Braham, Faouzi Maatouk, Salem Abdesselem, Mokdad Ayari, Riadh Garbaa, Nabil Hamrouni, Dorra Mbarek, Hajer Rekik, Hamda Zaghdoudi, Wacef Ayadi, Feriel Baraket, Karim Ben Brahim, Mariem Ben Romdhane, Habib Bousadia, Wassim Brahim, Malek Mezri, Ali Guesmi, Taha Ounissi, Sofiene Kammoun, Wajih Smati, Samir Tlili, Karim Zoughi, Jawher Zemni, Mahmoud Cheikh Bouhlel, Sanaa Islem, Rym Jemli, Anissa Joulak, Khadija Mzoughi, Hela Naanea, Leila Hached, Moufid Hadrich, Mohamed Hmem, Slim Kacem, Ikram Kammoun, Rawdha Othmani, Amel Ouerghi, Syrine Abid, Ridha Ennouri, Sandrine Haidar, Sihem Heraiech, Monia Jammali, Mourad Jarrar, Leila Riahi, Basma Trimech, Med Ali Azaiez, Foued Azzouzi, Khaled Ben Jemaa, Oussema Ben Rejab, Rim Chrigui, Wejdene Wechtati, Essia Boughzela, Gouider Jridi, Leila Bezdah, Sondes Kraiem, Habiba Drissa, Soraya Ben Youssef, Wafa Fehri, Salem Kachboura, Habib Gamra, Samir Kammoun, Mohamed Sami Mourali, Faouzi Addad, Leila Abid

Abstract

Background: Contemporary registries on atrial fibrillation (AF) are scare in North African countries.

Hypothesis: In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal.

Methods: NATURE-AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one-year follow-up period. All the patients with an Electrocardiogram-documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described.

Results: A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2 DS2 VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12-month follow-up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died.

Conclusions: NATURE-AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

Keywords: North Africa; anticoagulation; atrial fibrillation; management; outcomes; risk scores.

Conflict of interest statement

The authors declare no potential conflict of interests.

© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
Distribution of Antithrombotic drug use in valvular and nonvalvular AF patients according to CHA2DS2VASc score
FIGURE 2
FIGURE 2
Kaplan–Meier plot: Thromboembolic complications (Panel A), Bleeding complications (Panel B) and death (Panel C) during follow‐up (survival in weeks (Moy, IC 95%) 62.4 [59.6–65.3])

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Source: PubMed

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