Atrial fibrillation in low- and middle-income countries: a narrative review
Itamar S Santos, Alessandra C. Goulart, Rodrigo Díaz Olmos, G. Neil Thomas, Gregory Y.H. Lip, Paulo A. Lotufo, Isabela M. Benseñor, the NIHR Global Health Group on Atrial Fibrillation Management, Ajini Arasalingam, Isabela M. Benseñor, Peter Brocklehurst, Kar Keung Cheng, Mei Feng, Alessandra C. Goulart, Sheila Greenfield, Yutao Guo, Mahesan Guruparan, Gustavo Gusso, Wang Hao, Lindsey Humphreys, Balachandran Kumarendran, Kate Jolly, Sue Jowett, Emma Lancashire, Deirdre A. Lane, Xuewen Li, Yan‐Guang Li, Gregory Y H Lip, Trudie Lobban, Paulo A. Lotufo, Semira Manseki-Holland, David Moore, Krishnarajah Nirantharakumar, Rodrigo Díaz Olmos, Itamar S Santos, Alena Shantsila, Isabelle Szmigin, Kumaran Subaschandren, Rajendra Surenthirakumaran, G. Neil Thomas, Jingya Wang
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.