Predictors of atrial fibrillation among patients with acute ischemic stroke attending regional referral hospitals in Dar es Salaam
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Date
2025
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Kairuki University
Abstract
Background: Atrial fibrillation (AF) is a sustained cardiac arrhythmia and a major independent risk factor for ischemic stroke, often associated with increased stroke severity, poor functional outcomes, and higher mortality. In Tanzania, limited data exist on the prevalence and predictors of AF among acute ischemic stroke (AIS) patients, particularly in Dar-es-salaam.
Objective: To determine the predictors for AF among patients with acute AIS attending Regional Referral Hospitals in Dar es Salaam, Tanzania.
Methodology: A hospital-based cross-sectional analytical study was conducted from October 2024 to July 2025 at three regional referral hospitals. Consecutive adult patients (≥18 years) with CT-confirmed AIS within 7 days of onset were enrolled. Data on sociodemographic characteristics, clinical history, and stroke severity using the National Institutes of Health Stroke Scale (NIHSS) were collected. A standard 12-lead ECG was performed on all participants to detect AF. Associations between independent variables and AF were assessed using generalized linear models with Poisson distribution and robust variance estimation.
Results: A total of 119 AIS patients were included (mean age 64 years; 58% female). The prevalence of AF was 16% (n=19). In multivariable analysis, age >60 years was a strong independent predictor of AF (aPR = 22.3, 95% CI: 3.1–161.0, p=0.002), and a
higher level of education was protective for AF (aPR 0.07, 95% CI: 0.01-0.32, p=0.0007). Hypertension was present in all AF patients (100%), while the combination of hypertension and heart failure markedly increased AF risk (aPR = 7.53, 95% CI: 2.69
21.08, p=0.0001). Poor adherence to medications also increased the risk of AF. Patients with AF presented with significantly higher NIHSS scores, indicating greater stroke severity. Conclusion: AF was present in approximately one in six AIS patients, with advanced age, low education level, hypertension, comorbid heart failure and poor adherence to medication being significant predictors. AF was also associated with more severe strokes. Routine AF screening, especially among elderly and hypertensive stroke patients, and early initiation of appropriate secondary prevention strategies are warranted in Tanzania’s
hospitals.
Description
A dissertation submitted in (partial) fulfillment of the requirements for the Degree of Master of Medicine (Internal Medicine) at Kairuki University
Keywords
atrial fibrillation, ischemic stroke, cardiac arrhythmias
Citation
Salim, Moza M. 2025. Predictors of atrial fibrillation among patients with acute ischemic stroke attending regional referral hospitals in Dar es Salaam. Dissertation. Kairuki University