# Description of Atrial Fibrillation in a Cardiology Department in Mahajanga, Madagascar

## TL;DR

This study reports on the prevalence and management of atrial fibrillation in a Malagasy cardiology department, highlighting gaps in care.

## Contribution

Provides the first detailed description of AF in Madagascar, a region with limited cardiovascular data.

## Key findings

- Atrial fibrillation prevalence was 5.27% in the studied cardiology department.
- Most patients had a high stroke risk score but were inadequately anticoagulated.
- Therapeutic strategies often deviated from current international guidelines.

## Abstract

Introduction

Despite the increasing development of research on atrial fibrillation (AF), epidemiologic data remain limited in certain regions, particularly Madagascar. Madagascar is a country with limited resources and data on the cardiovascular health of the population. Our objectives were to report the prevalence of AF and to describe patient characteristics.

Materials and methods

This was a retrospective descriptive study that included 103 patients with AF during their hospitalization at the cardiology department of the Mahavoky Atsimo University Hospital in Mahajanga between January 2015 and July 2023.

Results

The prevalence of AF was 5.27%. The mean age of the patients was 59.53 years (±17.88), and the sex ratio was 1.10. All patients were symptomatic, and dyspnea (53.40%; n = 55) was the main symptom. Signs of heart failure (HF) were observed in 70.87% of cases (n = 73). The majority of patients (87.38%; n = 90) had a CHA2DS2-VASc (congestive HF, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, sex category) score ≥ 2, and of these, 10 patients were not anticoagulated. Vitamin K antagonists and direct oral anticoagulants were prescribed in 71.84% (n = 74) and 9.71% (n = 10) of cases, respectively. Rate control was the most commonly used therapeutic strategy. Spontaneous return to sinus rhythm occurred in 14 patients (13.59%). Twelve patients (11.65%) had a stroke, and one patient (0.97%) died during a mean hospital stay of 6.92 days (±4.7).

Conclusions

This study provides an overview of the situation in Madagascar. Management is far from meeting current recommendations for good practice, which is a major challenge.