The atrial fibrillation registry in countries of Africa: Rationale and design of Africa

Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of stroke, heart failure, and death. Oral anticoagulants (OACs) are the cornerstone of AF management and effectively prevent AF-related stroke. As new non-vitamin K antagonist OACs (NOACs) have become available, the landscape of stroke prevention in AF has changed. Data on contemporary treatment patterns and outcomes associated with AF in clinical practice are very limited for patients in sub-Saharan Africa. Methods/design The atrial fibrillation registry in countries of Africa (AFRICA) is a multicenter, prospective, ambulatory-based registry of incident and prevalent AF. The registry will be an international collaboration of health care providers and cardiologists from 25 countries in sub-Saharan Africa. The initial goal of enrolling 5000 patients is to capture a large, representative population of patients with AF in these countries. Enrolled patients will be observed for ≥ 2 years from 2018 to 2022. Because the registry design is adaptive in nature, sample size can be modified during the course of the study to ensure adequacy of the registry to answer targeted research questions. The goal is to describe baseline characteristics, identify specific aspects and characterize treatment and outcomes of patients with AF in sub-Saharan Africa. Conclusion There are considerable gaps between daily clinical practice and current guideline-based recommendations (mainly based on non-African studies) for therapy in many healthcare systems. The atrial fibrillation registry in countries of Africa will provide insights into “real-world” treatment including rate and rhythm control, stroke prevention, transitions to new therapies, and clinical outcomes among patients with AF in sub-Saharan Africa. This would promote better quality of AF care and improved patient outcomes worldwide.