Atrial fibrillation in low- and middle-income countries: a narrative review
Author:
Santos Itamar S12, Goulart Alessandra C12, Olmos Rodrigo D12, Thomas G Neil3, Lip Gregory Y H345, Lotufo Paulo A12, Benseñor Isabela M12, Arasalingam Ajini, Benseñor Isabela, Brocklehurst Peter, Cheng Kar Keung, Feng Mei, Goulart Alessandra C, Greenfield Sheila, Guo Yutao, Guruparan Mahesan, Gusso Gustavo, Hao Wang, Humphreys Lindsey, Kumarendran Balachandran, Jolly Kate, Jowett Sue, Lancashire Emma, Lane Deirdre A, Li Xuewen, Li Yanguang, Lip Gregory Y H, Lobban Trudie, Lotufo Paulo, Manseki-Holland Semira, Moore David, Nirantharakumar Krishnarajah, Olmos Rodrigo, Santos Itamar S, Shantsila Alena, Szmigin Isabelle, Subaschandren Kumaran, Surenthirakumaran Rajendra, Neil Thomas G, Wang Jingya,
Affiliation:
1. Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, Av. Lineu Prestes 2565, Cidade Universitária, São Paulo 05508-000, Brazil 2. Internal Medicine Deparment, School of Medicine, Universidade de São Paulo, São Paulo, Brazil 3. Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK 4. Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, UK 5. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Abstract
Abstract
Preventing premature non-communicable disease mortality necessitates a thorough review of one of the most important risk factors for stroke, which is atrial fibrillation (AF). The latter and AF-related stroke are still considered to be problems of high-income countries and are frequently overlooked in low- and middle-income countries (LMICs). In this narrative review, we provide an overview of studies that evaluated at least one of the following determinants of AF burden in LMICs: current epidemiology and trends, stroke prevention, health outcomes, and economic burden. Studies focusing on samples close to the general population (including community- and primary care-based samples) indicate sex-specific prevalence rates up to 7.4% in LMICs. Although AF prevalence is still higher in high-income countries than LMICs, the gap in AF burden between these two groups has been reducing in the past three decades. Oral anticoagulant (OAC) therapy for stroke prevention is underused in LMICs, and there are little data on OAC therapy in relation to stroke risk scores, such as CHA2DS2-VASc. Available data also points to higher morbidity and mortality for patient with AF in LMICs than their counterparts in high-income countries. Data on the consequent economic burden in LMICs is scarce, but it is reasonable to consider it will follow the same trend as that observed for health outcomes. Raising the visibility of AF as a public health problem in LMICs is necessary as a first step to providing adequate care for patients with this condition.
Funder
Boehringer Ingelheim
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine
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