The prevalence of atrial fibrillation in patients with ischaemic stroke in a district hospital in the Western Cape

Master Thesis


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Background Cerebrovascular disease remains one of the leading causes of morbidity and mortality globally. In South Africa, cerebrovascular disease was the fourth leading cause of death in 2016, responsible for 5.1 % of all deaths - the leading cause of death in individuals 65 years and older. Atrial fibrillation accounts for 15% of all strokes and a 25% of patients with AF-related stroke have this arrhythmia diagnosed at the time of the stroke. Objectives This study sets out to determine the prevalence of atrial fibrillation in patients with ischaemic stroke, as confirmed on CT scan, at a district level hospital in the Western Cape, South Africa. Methods This descriptive study was conducted at Mitchell’s Plain Hospital in Cape Town and data was collected over a year. Patients diagnosed with a stroke were identified from an electronic patient register and relevant radiology and clinical data was sourced retrospectively. The diagnosis of ischaemic stroke was confirmed by a CT scan report and ECGs were independently screened by two Emergency Physicians. Categorical data was described in percentages and descriptive statistics. Continuous variables were described by median and interquartile range (IQR). Statistical significance is defined as a p< 0.05. Categorical data was compared using the Fisher’s exact test. This project has been approved by UCT Human Research Ethics Committee [790/2018]. Results The proportion of adult patients with a diagnosis of stroke was 2%. Of those, 64% had ischaemic strokes, 9% had intracranial bleeds, 20% did not have a CT scan and 7% had stroke mimics. 11% of all participants with ischaemic stroke had atrial fibrillation, 67% of those presumed new. A total of 90 (22%) of all participants with ischaemic stroke was less than 51 years of age. The mortality rate was statistically higher in patients who had AF. Conclusion The results from this study suggests that screening practices to detect both Atrial Fibrillation in asymptomatic patients, as well as in those with an ischaemic stroke, are not effective. With the increasing population life expectancy, and prevalence of cardiovascular disease, the prevalence of AF and its complications will increase. Since the risk of stroke related to AF can be reduced significantly by oral anticoagulation, further studies should aim to explore barriers and challenges to effective screening.