A review of the epidemiology of atrial fibrillation in sub-Saharan Africa

J Cardiovasc Electrophysiol. 2019 Dec;30(12):3006-3016. doi: 10.1111/jce.14222. Epub 2019 Nov 10.


This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub-Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community-based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one-third of patients with AF, and valvular heart disease (12.3%-44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.

Keywords: Africa; anticoagulation; atrial fibrillation; complications; prevalence; risk factors; treatment.

Publication types

  • Systematic Review

MeSH terms

  • Action Potentials
  • Adult
  • Africa South of the Sahara / epidemiology
  • Aged
  • Anti-Arrhythmia Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology*
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy
  • Cardiac Catheterization / instrumentation
  • Cardiac Pacing, Artificial
  • Catheter Ablation
  • Electric Countershock
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Heart Conduction System / physiopathology
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prevalence
  • Risk Factors
  • Treatment Outcome


  • Anti-Arrhythmia Agents
  • Anticoagulants
  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors