{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T23:26:57Z","timestamp":1784935617763,"version":"3.55.0"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T00:00:00Z","timestamp":1642464000000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100030670","name":"Mulago Foundation","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100030670","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01TW010281"],"award-info":[{"award-number":["K01TW010281"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 HL152926"],"award-info":[{"award-number":["K23 HL152926"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,1,5]]},"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A prospective cohort study using data collected between October 2018 and May 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Outpatient clinic at a tertiary hospital in Mwanza, Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>303 adult participants (aged \u226518 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of &lt;3 months (ie, advance solid tumours, advance haematological malignancies) were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We enrolled 403 participants with HF (mean age 60\u00b119 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31\/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95%\u2009CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (&gt;110\u2009bpm, HR 1.879, 95%\u2009CI 1.508 to 2.340, p&lt;0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-058200","type":"journal-article","created":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T10:52:12Z","timestamp":1642589532000},"page":"e058200","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0418-1705","authenticated-orcid":false,"given":"Yunchan","family":"Chen","sequence":"first","affiliation":[{"name":"Weill Cornell Medicine, New York, New York, USA"},{"name":"Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Alphonce","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Mujuni","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey A","family":"Kisigo","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, New York, USA"},{"name":"Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin R","family":"Kingery","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, New York, USA"},{"name":"Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel","family":"Makubi","sequence":"additional","affiliation":[{"name":"Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RN","family":"Peck","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, New York, USA"},{"name":"Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrick","family":"Kalokola","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,1,19]]},"reference":[{"key":"2025120519181708000_12.1.e058200.1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1038\/nrcardio.2017.19","article-title":"Cardiovascular disease in Africa: epidemiological profile and challenges","volume":"14","author":"Keates","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"2025120519181708000_12.1.e058200.2","doi-asserted-by":"publisher","DOI":"10.15420\/cfr.2016"},{"key":"2025120519181708000_12.1.e058200.3","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-912"},{"key":"2025120519181708000_12.1.e058200.4","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2015-036"},{"key":"2025120519181708000_12.1.e058200.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.12.048"},{"key":"2025120519181708000_12.1.e058200.6","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ijcard.2017.05.025","article-title":"Heart failure, post-hospital mortality and renal function in Tanzania: a prospective cohort study","volume":"243","author":"Kingery","year":"2017","journal-title":"Int J Cardiol"},{"key":"2025120519181708000_12.1.e058200.7","doi-asserted-by":"crossref","DOI":"10.5455\/msm.2017.29.231-236","article-title":"The impact of risk factors and comorbidities on the incidence of atrial fibrillation","volume":"29","author":"Naser","year":"2017","journal-title":"Mater Sociomed"},{"key":"2025120519181708000_12.1.e058200.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.786244"},{"key":"2025120519181708000_12.1.e058200.9","doi-asserted-by":"crossref","DOI":"10.1016\/j.gheart.2014.01.004","article-title":"Global burden of atrial fibrillation in developed and developing nations","volume":"9","author":"Chugh","year":"2014","journal-title":"Glob Heart"},{"key":"2025120519181708000_12.1.e058200.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00297-6"},{"key":"2025120519181708000_12.1.e058200.11","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/S0002-9149(02)03373-8","article-title":"Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy","volume":"91","author":"Maisel","year":"2003","journal-title":"Am J Cardiol"},{"key":"2025120519181708000_12.1.e058200.12","doi-asserted-by":"crossref","first-page":"e285","DOI":"10.1016\/S2214-109X(14)70033-6","article-title":"Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey","volume":"2","author":"Peck","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2025120519181708000_12.1.e058200.13","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12560"},{"key":"2025120519181708000_12.1.e058200.14","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"Esc guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"2016","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"2025120519181708000_12.1.e058200.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197112232852601"},{"key":"2025120519181708000_12.1.e058200.16","first-page":"81","article-title":"\"How much should I weigh?\"--Quetelet's equation, upper weight limits, and BMI prime","volume":"70","author":"Gadzik","year":"2006","journal-title":"Conn Med"},{"key":"2025120519181708000_12.1.e058200.17","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw210"},{"key":"2025120519181708000_12.1.e058200.18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/bimj.4710350205","article-title":"Rosner, B.: fundamentals of biostatistics, third edition. PWS-Kent, Boston 1990, XV, 655 pp., us $ 14.95, ISBN 0-534-91973-1","volume":"35","author":"Sa\u0144chez","year":"1993","journal-title":"Biom. J."},{"key":"2025120519181708000_12.1.e058200.19","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-305599"},{"key":"2025120519181708000_12.1.e058200.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-022320"},{"key":"2025120519181708000_12.1.e058200.21","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000127692.23278.a9"},{"key":"2025120519181708000_12.1.e058200.22","doi-asserted-by":"crossref","first-page":"122","DOI":"10.21315\/mjms2018.25.4.12","article-title":"Sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical data","volume":"25","author":"Bujang","year":"2018","journal-title":"Malays J Med Sci"},{"key":"2025120519181708000_12.1.e058200.23","first-page":"308","article-title":"A clinical study of pattern and factors affecting outcome in Nigerian patients with advanced heart failure","volume":"18","author":"Familoni","year":"2007","journal-title":"Cardiovasc J Afr"},{"key":"2025120519181708000_12.1.e058200.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2003.12.004"},{"key":"2025120519181708000_12.1.e058200.25","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1111\/jch.12646","article-title":"Hypertension control and its correlates among adults attending a hypertension clinic in Tanzania","volume":"18","author":"Maginga","year":"2016","journal-title":"J Clin Hypertens"},{"key":"2025120519181708000_12.1.e058200.26","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.10.946"},{"key":"2025120519181708000_12.1.e058200.27","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1093\/eurheartj\/ehw570","article-title":"Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril\/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF","volume":"38","author":"B\u00f6hm","year":"2017","journal-title":"Eur Heart J"},{"key":"2025120519181708000_12.1.e058200.28","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.26.3.w380"},{"key":"2025120519181708000_12.1.e058200.29","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(87)90666-1"},{"key":"2025120519181708000_12.1.e058200.30","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61171-X"},{"key":"2025120519181708000_12.1.e058200.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2010.04.013"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-058200","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T03:18:23Z","timestamp":1764991103000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-058200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,19]]},"published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1136\/bmjopen-2021-058200"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-058200","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]}}}