Cardiac imaging correlates and predictors of stroke in patients with atrial fibrillation: a meta-analysis.

BACKGROUND: New nonclinical parameters are needed to improve the current stroke risk stratification schemes for patients with atrial fibrillation. This study aimed to summarize data on potential cardiac imaging correlates and predictors of stroke or systemic embolism in patients with atrial fibrillation. METHODS: MEDLINE, EMBASE, and Web of Science were searched to identify all published studies providing relevant data through 16 November 2022. Random effects meta-analysis method was used to pool estimates. RESULTS: We included 64 studies reporting data from a pooled population of 56 639 patients. Left atrial spontaneous echo-contrast [adjusted odds ratio (aOR) 3.32, 95% confidence interval (CI) 1.98-5.49], nonchicken wing left atrial appendage (LAA) morphology (aOR 2.15, 95% CI 1.11-4.18), left atrial enlargement (aOR 2.12, 95% CI 1.45-3.08), and higher LAA orifice diameter (aOR 1.56, 95% CI 1.18-2.05) were highly associated with stroke. Other parameters associated with stroke included higher left atrial sphericity (aOR 1.14, 95% CI 1.01-1.29), higher left atrial volume (aOR 1.03, 95% CI 1.01-1.04), higher left atrial volume index (aOR 1.014, 95% CI 1.004-1.023), lower left atrial reservoir strain [adjusted hazard ratio (aHR) 0.86, 95% CI 0.76-0.98], higher left ventricular mass index (aOR 1.010, 95% CI 1.005-1.015) and E / e' ratio (aOR 1.12, 95% CI 1.07-1.16). There was no association between LAA volume (aOR 1.37, 95% CI 0.85-2.21) and stroke. CONCLUSION: These cardiac imaging parameters identified as potential predictors of thromboembolism may improve the accuracy of stroke risk stratification schemes in patients with atrial fibrillation. Further studies should evaluate the performance of holistic risk scores including clinical factors, biomarkers, and cardiac imaging.

Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis.

OBJECTIVE: To summarize data on the prevalence/incidence, risk factors and prognosis of atrial fibrillation (AF) in patients with acute pulmonary embolism (aPE). METHODS: MEDLINE, Embase, and Web of Science were searched to identify all published studies providing relevant data through December 12, 2021. Random-effects meta-analysis method was used to pool estimates. RESULTS: We included 27 studies reporting data from a pooled population of 819,380 patients. The prevalence rates were 11.3% for pre-existing AF, 4.7% for newly diagnosed AF, and 13.2% for prevalent (total) AF. Predictors of newly diagnosed AF (from one study) included congestive heart failure (adjusted odds ratio [aOR] 3.33, 95% CI: 1.81-6.12), ischemic heart disease (aOR 3.25, 95% CI: 1.65-6.39), massive PE (aOR 2.67, 95% CI: 1.19-5.99). Overall, AF was associated with increased risk of short-term (aOR 1.54, 95% CI: 1.44-1.64) and long-term mortality (aOR 1.58, 95% CI: 1.26-1.97). In subgroup analyses, all types of AF were associated with increased risk of short-term mortality: pre-existing AF (aOR 1.90, 95% CI: 1.59-2.27), newly diagnosed AF (aOR 1.51, 95% CI: 1.18-1.93), and prevalent AF (aOR 1.50, 95% CI: 1.42-1.60). Pre-existing AF (aOR 2.08, 95% CI: 1.27-3.42) and prevalent AF (aOR 1.29, 95% CI: 1.02-1.63) were also associated with higher long-term mortality. CONCLUSION: AF is present in about one in eight patients with aPE, and is associated with increased short- and long-term mortality. AF might improve risk stratification in patients with aPE.

Geographic distribution of metabolic syndrome and its components in the general adult population: A meta-analysis of global data from 28 million individuals.

AIMS: Better knowledge of the global metabolic syndrome (MetS) prevalence and its components is a prerequisite to curb the related burden. METHODS: We systematically searched PubMed, EMBASE, Web of Knowledge, Africa Journal Online, Global Index Medicus up to May 23, 2021. Prevalence pooling was done with a random-effects meta-analysis. RESULTS: In total, 1,129 prevalence data (28,193,768 participants) were included. The MetS global prevalence varied from 12.5% (95 %CI: 10.2-15.0) to 31.4% (29.8-33.0) according to the definition considered. The prevalence was significantly higher in Eastern Mediterranean Region and Americas and increased with country's level of income. The global prevalence was 45.1% (95 %CI: 42.1-48.2) for ethnic-specific central obesity, 42.6% (40.3-44.9) for systolic blood pressure (BP) ≥ 130 mmHg and/or diastolic BP ≥ 85 mmHg, 40.2% (37.8-42.5) for HDL-cholesterol < 1.03 for men or < 1.29 mmol/L for women, 28.9% (27.4-30.5) for serum triglycerides ≥ 1.7 mmol/L, and 24.5% (22.5-26.6) for fasting plasma glucose ≥ 5.6 mmol/L. CONCLUSIONS: This study reveals that MetS and its related cardiometabolic components are highly prevalent worldwide. This study calls for more aggressive and contextualized public health interventions to tackle these conditions.

Sex disparities in enrollment and reporting of outcomes by sex in contemporary clinical trials of atrial fibrillation.

BACKGROUND: Underrepresentation of females in randomized controlled trials (RCTs) limits generalizability and quality of the evidence guiding treatment of females. This study aimed to measure the sex disparities in participants' recruitment in RCTs of atrial fibrillation (AF) and determine associated factors, and to describe the frequency of outcomes reported by sex. METHODS: MEDLINE was searched to identify RCTs of AF published between January 1, 2011, and November 20, 2021, in 12 top-tier journals. We measured the enrollment of females using the enrollment disparity difference (EDD) which is the difference between the proportion of females in the trial and the proportion of females with AF in the underlying general population (obtained from the Global Burden of Disease). Random-effects meta-analyses of the EDD were performed, and multivariable meta-regression was used to explore factors associated with disparity estimates. We also determined the proportion of trials that included sex-stratified results. RESULTS: Out of 1133 records screened, 142 trials were included, reporting on a total of 133 532 participants. The random-effects summary EDD was -0.125 (95% confidence interval [CI] = -0.143 to -0.108), indicating that females were under-enrolled by 12.5 percentage points. Female enrollment was higher in trials with higher sample size (<250 vs. >750, adjusted odds ratio [aOR] 1.065, 95% CI: 1.008-1.125), higher mean participants' age (aOR: 1.006, 95% CI: 1.002-1.009), and lower in trials conducted in North America compared to Europe (aOR: 0.945, 95% CI: 0.898-0.995). Only 36 trials (25.4%) reported outcomes by sex, and of these 29 (80.6%) performed statistical testing of the sex-by-treatment interaction. CONCLUSION: Females remain substantially less represented in RCTs of AF, and sex-stratified reporting of primary outcomes is infrequent. These findings call for urgent action to improve sex equity in enrollment and sex-stratified outcomes' reporting in RCTs of AF.

Global, regional, and country estimates of metabolic syndrome burden in children and adolescents in 2020: a systematic review and modelling analysis.

BACKGROUND: Halting the rise in cardiometabolic risk factors in children and adolescents is crucial to curb the global burden of cardiovascular diseases. We aim to provide global, regional, and national estimates of the prevalence of metabolic syndrome in children and adolescents to support the development of evidence-based prevention strategies. METHODS: In this systematic review with modelling analysis, we searched PubMed, Embase, Africa Journal Online, and Global Index Medicus from database inception to Jan 30, 2021, with no restriction on language or geographical location. We included community-based and school-based cross-sectional studies and cross-sectional analysis of cohort studies that reported prevalence of metabolic syndrome in the general population of children (6-12 years) and adolescents (13-18 years). Only studies with a low risk of bias were considered. Eligible studies included at least 200 participants and used probabilistic-based sampling. Diagnosis of metabolic syndrome had to meet at least three of the following criteria: high systolic or diastolic blood pressure (≥90th percentile for age, sex, and height); waist circumference in at least the 90th percentile for age, sex, and ethnic group; fasting plasma glucose 5·6 mmol/L or greater; fasting plasma triglycerides 1·24 mmol/L or greater; and fasting plasma high density lipoprotein cholesterol 1·03 mmol/L or less. Independent investigators selected eligible studies and extracted relevant data. The primary outcome was a crude estimate of metabolic syndrome prevalence, assessed using a Bayesian hierarchical model. FINDINGS: Our search yielded 6808 items, of which 169 studies were eligible for analysis, including 306 prevalence datapoints, with 550 405 children and adolescents from 44 countries in 13 regions. The between-study variance (τ2) was 0·52 (95% CI 0·42-0·67), which could reflect the measurement of each component of the metabolic syndrome and covariates as sources of between-study heterogeneity. We estimated the global prevalence of metabolic syndrome in 2020 at 2·8% (95% uncertainty interval [UI] 1·4-6·7) for children and 4·8% (2·9-8·5) for adolescents, equating to around 25·8 (12·6-61·0) million children and 35·5 (21·3-63·0) million adolescents living with metabolic syndrome. In children, the prevalence of metabolic syndrome was 2·2% (95% UI 1·4-3·6) in high-income countries, 3·1% (2·5-4·3) in upper-middle-income countries, 2·6% (0·9-8·3) in lower-middle-income countries, and 3·5% (1·0-8·0) in low-income countries. In adolescents, the prevalence of metabolic syndrome was 5·5% (4·1-8·4) in high-income countries, 3·9% (3·1-5·4) in upper-middle-income countries, 4·5% (2·6-8·4) in lower-middle-income countries, and 7·0% (2·4-15·7) in low-income countries. Prevalence in children varied from 1·4% (0·6-3·1) in northwestern Europe to 8·2% (6·9-10·1) in Central Latin America. Prevalence for adolescents ranged from 2·9% (95% UI 2·6-3·3) in east Asia to 6·7% (5·9-8·3) in high-income English-speaking countries. The three countries with the highest prevalence estimates in children were Nicaragua (5·2%, 2·8-10·4), Iran (8·8%, 8·0-9·6), and Mexico (12·3%, 11·0-13·7); and the three countries with the highest prevalence estimates in adolescents were Iran (9·0%, 8·4-9·7), United Arab Emirates (9·8%, 8·5-10·3), and Spain (9·9%, 9·1-10·8). INTERPRETATION: In 2020, about 3% of children and 5% of adolescents had metabolic syndrome, with some variation across countries and regions. The prevalence of metabolic syndrome was not consistently higher with increasing level of development, suggesting that the problem is not mainly driven by country wealth. The high number of children and adolescents living with metabolic syndrome globally highlights the urgent need for multisectoral interventions to reduce the global burden of metabolic syndrome and the conditions that lead to it, including childhood overweight and obesity. FUNDING: None.

Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis.

BACKGROUND: The epidemiology of infective endocarditis in Africa is inadequately characterised. We therefore aimed to comprehensively summarise the available data for the incidence, risk factors, clinical pattern, microbiology, and outcomes of infective endocarditis in Africa. METHODS: We did a systematic review and meta-analysis. We searched PubMed, Embase, African Index Medicus, and African Journals Online for all studies reporting primary data for the epidemiology of infective endocarditis in populations within Africa, published from inception to Jan 14, 2021, irrespective of the language. We used the search terms "endocarditis", "Africa", and the name of all African countries in the search strategy. We excluded articles that did not include primary data, primary studies with a small sample size (<30 participants), and those that report findings from before 1990. We recorded data for study characteristics, sample size, criteria used to define infective endocarditis, risk factors, potential entry site, clinical patterns, microbiology profile, outcomes including complications such as embolic events, heart failure, acute kidney injury, and death, and predictors of death. We used random-effects meta-analysis method to pool estimates. This study is registered with PROSPERO, CRD42021243842. FINDINGS: We retrieved 2141 records from the database and bibliographic searches, of which a total of 42 studies were included in this systematic review. Rheumatic heart disease was the most common risk factor for infective endocarditis in adults (52·0% [95% CI 42·4-61·5]), whereas congenital heart disease was the most common risk factor for infective endocarditis in children (44·7% [29·5-60·5]). Microbiological testing (mostly blood cultures) was positive in 48·6% (95% CI 42·2-51·1) of patients with infective endocarditis, with Staphylococcus species (41·3% [95% CI 36·2-46·5]) and Streptococcus species (34·0% [29·0-39·3]) the most commonly identified microorganisms. The pooled rate of surgical treatment of infective endocarditis was 49·1% (95% CI 43·2-55·1). The pooled in-hospital mortality rate was 22·6% (95% CI 19·5-25·9). Other frequent complications included heart failure (47·0% [95% CI 38·2-56·0]), acute kidney injury (22·8% [18·8-27·0]), and embolic events (31·1% [22·2-40·7]). INTERPRETATION: As the most prevalent risk factor in Africa, rheumatic heart disease should be central in interventions to reduce the burden of infective endocarditis on the continent. In tertiary hospitals with good access to cardiac surgery, the outcomes of infective endocarditis seem relatively similar to what has been reported in other parts of the world, especially in high-income countries. FUNDING: None.

Atrial thrombus detection on transoesophageal echocardiography in patients with atrial fibrillation undergoing cardioversion or catheter ablation: A pooled analysis of rates and predictors.

OBJECTIVE: To summarize data on the rates and predictors of left atrial thrombus/left atrial appendage thrombus (LAT/LAAT) detection by transoesophageal echocardiography (TEE) before electrical cardioversion (ECV) or catheter ablation (CA) for atrial fibrillation (AF). METHODS: EMBASE, MEDLINE, and Web of Science Core Collection were searched to identify all studies providing relevant data and published by October 7, 2020. A random-effects meta-analysis method was used to pool effect size estimates. RESULTS: A total of 85 studies were included, reporting data from 56 660 patients with AF. In patients undergoing CA and ECV, the pooled prevalence of LAT/LAAT was 1.8% and 7.5% in those not on oral anticoagulation (OAC), 1.8% and 5.5% in those taking OAC, and 1.3% and 4.9% in case of adequate OAC, respectively. According to the type of OAC, the prevalence was 2.0% and 7.6% for vitamin K antagonist, 1.3% and 3.5% for direct oral anticoagulant. Predictors of LAT/LAAT detection were nonparoxysmal AF (odds ratio [OR]: 3.6, 95% confidence interval: 2.4-5.2), hypertension (OR: 2.9, 1.2-7.0), previous stroke (OR: 3.0, 1.6-5.63), heart failure (OR: 4.3, 2.7-6.8), and CHADS2 score ≥2 (OR: 3.3, 1.9-5.8) for patients undergoing CA; and heart failure (OR: 2.8, 1.3-6.2) and the CHA2 DS2 -VASc score (OR: 2.55, 1.5-4.5) for those undergoing ECV. CONCLUSION: The prevalence of LAT/LAAT in AF patients undergoing ECV or CA varies widely, mainly due to differences in patient risk profiles and OAC types. Further research should determine whether the predictors of LAT/LAAT detection identified by this study could be used to select patients who require preprocedural TEE.

Accuracy of the novel Peguero Lo-Presti criterion for electrocardiographic detection of left ventricular hypertrophy in a black African population.

The diagnostic accuracy of the electrocardiogram for left ventricular hypertrophy (LVH) is limited. Recently, Peguero and collaborators proposed a novel voltage criterion for its detection with reportedly higher accuracy than the commonly used Cornell and Sokolow-Lyon criteria. While studies done in various populations have confirmed it, there are no available data from black African populations. We conducted a cross-sectional study in a population from Cameroon to compare the Peguero-Lo Presti criterion to the older Cornell, Sokolow-Lyon, and Cornell product criteria, pertaining to their sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), with echocardiography as the reference standard. The study population consisted of 238 participants (54.2% female) with a mean age of 58 (SD 13) years. On echocardiography, the prevalence of LVH was 45.3% (n = 108). The sensitivity was 48.14%, 63.89%, 63.89%, and 67.29% for the Sokolow-Lyon, Peguero-Lo Presti, Cornell, and Cornell product criteria, respectively. The specificity was 73.84%, 75.97%, 79.23%, and 82.31% for the Peguero-Lo Presti, Cornell product, Cornell, and Sokolow-Lyon criteria, respectively. The overall accuracy of the Peguero-Lo Presti (AUC = 0.689) was not significantly different from that of the Cornell (AUC = 0.714), the Cornell product (AUC = 0.717), and the Sokolow-Lyon (AUC = 0.652) (all p Ëƒ .05). Hypertension and gender influenced the agreement between ECG criteria and echocardiography in the detection of LVH. In conclusion, in this black African population, Peguero-Lo Presti was not significantly more or less accurate than Cornell or Sokolow-Lyon.

Meta-Analysis of the Incidence, Prevalence, and Correlates of Atrial Fibrillation in Rheumatic Heart Disease.

Objective: To estimate the incidence, prevalence, and correlates of atrial fibrillation (AF) in a global population with rheumatic heart disease (RHD). Methods: Bibliographic databases were searched to identify all published studies providing data on AF in patients with RHD. Random-effects meta-analysis method was used to pool estimates. Results: Eighty-three studies were included, reporting data from 75,637 participants with RHD in 42 countries. The global prevalence of AF in RHD was 32.8% (range: 4.3%-79.9%). It was higher in severe valvular disease (30.8% vs 20.7%, p = 0.009), in severe mitral valve disease compared to severe aortic disease (30.4% vs 6.3%, p = 0.038). The global cumulative incidence of AF in patients with RHD was 4.8%, 11.4%, 13.2%, and 30.8% at 1, 2, 5, and 10 years of follow-up, respectively. From comparison between patients with and without AF, AF was associated with increased age (mean difference [MD]: 9.5 years; 95% CI: 7.8-1.3), advanced heart failure (odds ratio [OR]: 4.4; 95% CI 2.1-9.3), tricuspid valve involvement (OR: 4.0; 95% CI: 3.0-5.3), history of thromboembolism (OR: 6.2; 95% CI: 3.4-11.4), highly sensitive C-reactive protein (MD: 5.5 mg/dL; 95% CI: 1.2-9.8), systolic pulmonary arterial pressure (MD: 3.6 mmHg; 95% CI: 0.8-6.3), right atrium pressure (MD: 1.5 mmHg; 95% CI: 1.0-2.0), and left atrium diameter (MD: 8.1 mm; 95% CI: 5.5-10.7). Conclusions: About one-third of patients with RHD have AF, with an incidence which almost triples every five years after diagnosis. Factors associated with AF include age, advanced heart failure, thromboembolism, and few cardiac hemodynamics parameters.

A meta-analytic evaluation of the diagnostic accuracy of the electrocardiographic Peguero-Lo Presti criterion for left ventricular hypertrophy.

Although electrocardiography (ECG) is a cost-effective and convenient tool for routine screening of left ventricular hypertrophy (LVH), its performance has been shown to be poor. The Peguero-Lo Presti, a novel voltage criterion, was found to be potentially better than the most commonly used criteria. We conducted a systematic review and meta-analysis of its diagnostic accuracy compared to Cornell and Sokolow-Lyon voltage criteria. Bibliographic databases were searched to identify relevant articles. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (ROC) curves were performed for comparison. Ten studies reporting data from 5984 individuals were included in the meta-analysis. Peguero-Lo Presti had the highest pooled sensitivity (43.0%, 95% confidence interval [CI]: 30.2-56.9) followed by Cornell (26.1%; 95% CI: 16.9-37.9) and Sokolow Lyon (22.0%; 95% CI: 14.1-32.7). However, Peguero-Lo Presti had the lesser pooled specificity (90.5%; 95% CI: 86.3-93.5) and Cornell the highest (94.9%; 95% CI: 90.3-97.3). The pooled DOR was 6.63 (95% CI: 3.95-11.13), 5.50 (95% CI: 3.64-8.30), and 2.94 (95% CI: 2.20-3.92) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon, respectively. Peguero-Lo Presti had the best accuracy according to summary ROC curves, with an area under the curve of 0.827 compared to 0.715 for Cornell, and 0.623 for Sokolow-Lyon. In conclusion, according to this meta-analysis, Peguero-Lo Presti has a better diagnostic performance than Cornell and Sokolow-Lyon and might be more useful in routine clinical practice as a screening tool for LVH.

Neuroimaging findings in headache with normal neurologic examination: Systematic review and meta-analysis.

OBJECTIVE: To determine if pooled estimates of the prevalence of unexpected findings in patients with headache and normal neurologic examination support current expert opinion-based neuroimaging guidelines. METHODS: We searched PubMed and EMBASE for studies reporting neuroimaging findings in patients with headache and normal neurologic examination up to September 30, 2017. The overall and disease-specific prevalence of unexpected findings were pooled through random-effects meta-analysis. This study is registered with PROSPERO, registration number CRD42017079714. RESULTS: In forty-one studies including 15,760 participants, the overall prevalence of unexpected findings and normal variants was 17.5% (95% CI: 13.1-22.3). The prevalence was 26.6% (95% CI: 15.5-39.4) in studies using MRI only. The prevalence of vascular, neoplastic, and non-neoplastic findings was 6.6%, 1.4%, and 9.6%. The pooled disease-specific prevalence was 2.0% for stroke, 1.8% for aneurysms, 0.8% for subdural hematoma, 0.7% for hydrocephalus, 0.2% for glioma, and 0.1% for meningioma. In secondary analysis, there was 0.4% increase in the prevalence of vascular unexpected findings with each 1% increase in the proportion of migraine with aura (p-value for meta-regression = 0.005). CONCLUSIONS: In patients with headache and normal neurologic examination, important vascular and neoplastic unexpected findings are rare and better detected with MRI. This supports current American College of Radiology and European Headache Federation recommendations to avoid systematic imaging in such patients and prefer MRI when imaging is needed.

Global burden of hypertension among people living with HIV in the era of increased life expectancy: a systematic review and meta-analysis.

BACKGROUND: Although HIV infection and antiretroviral therapy (ART) increase the risk for hypertension in people living with HIV (PLHIV), the global and regional burden of hypertension in PLHIV is not well characterized. METHODS: In this systematic review and meta-analysis, we searched multiple databases for studies reporting on hypertension in PLHIV and conducted between 2007 and 2018. Meta-analysis through random-effect models served to obtain the pooled prevalence estimates. Heterogeneity was assessed via the χ test on Cochran's Q statistic. RESULTS: We included 194 studies (396 776 PLHIV from 61 countries). The global prevalence of hypertension was 23.6% [95% confidence interval (95% CI: 21.6-25.5)] with substantial heterogeneity. The regional distribution was Western and Central Europe and North America [28.1% (95% CI: 24.5-31.9)], West and Central Africa [23.5% (16.6-31.0)], Latin America and the Caribbean [22.0% (17.8-26.5)], Eastern and Southern Africa [19.9% (17.2-22.8)], and Asia and Pacific [16.5% (12.5-21.0)]; P = 0.0007. No study originated from the Middle East and North Africa, and Eastern Europe and Central Asia regions. The prevalence was higher in high-income countries than others (P = 0.0003) and higher in PLHIV taking ART than those ART-naive (P = 0.0003). The prevalence increased over time (mainly driven by Eastern and Southern Africa) and with age. There was no difference between men and women. We estimated that in 2018, there were 8.9 (95% CI: 8.3-9.6) million cases of hypertension in PLHIV globally, among whom 59.2% were living in Sub-Saharan Africa. CONCLUSION: Cost-effective strategies to curb the dreadful burden of hypertension among PLHIV are needed.

Global Burden of Hepatitis B Infection in People Living With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis.

BACKGROUND: This meta-analysis was conducted to estimate the global burden of hepatitis B virus (HBV) infection in people living with human immunodeficiency virus (PLWH). METHODS: We searched multiple databases for studies published between January 1990 and December 2017. HBV infection (hepatitis B surface antigen) was diagnosed with serological assays. A random-effects meta-analysis served to pool data. RESULTS: We included 358 studies (834 544 PLWH from 87 countries). The pooled prevalence of HBV infection was 8.4% (95% confidence interval [CI], 7.9%-8.8%), among which 26.8% (95% CI, 22.0%-31.9%) was positive to hepatitis B e antigen. HBV prevalence (with 95% CIs) differed according to region: West and Central Africa, 12.4% (11.0%-13.8%); Middle East and North Africa, 9.9% (6.0%-14.6%); Asia and the Pacific, 9.8% (8.7%-11.0%); Eastern and Southern Africa, 7.4% (6.4%-8.4%); Western and Central Europe and North America, 6.0% (5.5%-6.7%); and Latin America and the Caribbean, 5.1% (4.2%-6.2%) (P < .0001). The prevalence decreased from 10.4% in low-developed to 6.6% in highly developed countries (P < .0001) and increased from 7.3% in countries with HIV prevalence ≤1% to 9.7% in countries with HIV prevalence >1% (P < .0001). Globally, we estimated that there were 3 136 500 (95% CI, 2 952 000-3 284 100) cases of HBV in PLWH, with 73.8% of estimated regional cases from sub-Saharan Africa and 17.1% from Asia and the Pacific. CONCLUSIONS: This study suggests a high burden of HBV infection in PLWH, with disparities according to region, level of development, and country HIV prevalence.

Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies.

This systematic review and meta-analysis aimed to provide a contemporaneous estimate of the global burden of rheumatic heart disease (RHD) from echocardiographic population-based studies. We searched multiple databases between January 01, 1996 and October 17, 2017. Random-effect meta-analysis was used to pool data. We included 82 studies (1,090,792 participant) reporting data on the prevalence of RHD and 9 studies on the evolution of RHD lesions. The pooled prevalence of RHD was 26.1‰ (95%CI 19.2-33.1) and 11.3‰ (95%CI 7.2-16.2) for studies which used the World Heart Federation (WHF) and World Health Organization (WHO) criteria, respectively. The prevalence of RHD varied inversely with the level of a country's income, was lower with the WHO criteria compared to the WHF criteria, and was lowest in South East Asia. Definite RHD progressed in 7.5% (95% CI 1.5-17.6) of the cases, while 60.7% (95% CI 42.4-77.5) of cases remained stable over the course of follow-up. The proportion of cases borderline RHD who progressed to definite RHD was 11.3% (95% CI 6.9-16.5). The prevalence of RHD across WHO regions remains high. The highest prevalence of RHD was noted among studies which used the WHF diagnostic criteria. Definite RHD tends to progress or remain stable over time.

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

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.

Meta-analysis of Atrial Fibrillation in Patients With Various Cardiomyopathies.

Patients with cardiomyopathy are at risk of developing atrial fibrillation (AF) which is a strong risk factor for thromboembolic events, progression to heart failure, and mortality or heart transplantation. This systematic review and meta-analysis sought to estimate the prevalence of AF in a global population with cardiomyopathy. PubMed and EMBASE were searched from inception until June 30, 2017 for published articles on AF and major cardiomyopathies without language restrictions. Eligible papers were independently assessed for methodological qualities. The prevalence of AF in patients with cardiomyopathy was estimated using a random-effect model. The chi-square test on Cochrane's Q statistics was used to evaluate heterogeneity across studies. In total 220 full texts representing a population of 118,668 participants were included in the meta-analysis. The ages of the participants ranged from a median of 31 to 72 years. The proportion of males ranged from 3% to 97%. Considering only cardiomyopathies with more than one contributing study, the prevalence of AF was highest in participants with dilated (24% [95% confidence interval: 21 to 28]), ischemic (20% [8 to 35]), and hypertrophic (19% [17 to 21]) cardiomyopathies, and lowest in patients with peripartum cardiomyopathies (5% [1 to 11]). In conclusion, with the exception of peripartum cardiomyopathy, an average of 1 to 2 in every 10 patients with a cardiomyopathy had AF, with no gender difference. Future guidelines need to take into consideration the management of AF in all the forms of cardiomyopathy.

Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2·3 million patients with tuberculosis.

BACKGROUND: Although diabetes and poor glycaemic control significantly increase the risk of tuberculosis and adversely affect tuberculosis treatment outcomes, the global burden of diabetes in the context of tuberculosis remains unknown. We did a systematic review and meta-analysis to estimate the prevalence of diabetes among patients with tuberculosis at global, regional, and country levels. METHODS: We searched PubMed, Excerpta Medica Database, Web of Science, and Global Index Medicus to identify studies published between Jan 1, 1986, and June 15, 2017, on the prevalence of diabetes in patients with active tuberculosis, with no language restrictions. Criteria to diagnose tuberculosis and diabetes concurred with WHO guidelines. Methodological quality of eligible studies was assessed, and random-effect models meta-analysis served to obtain the pooled prevalence estimate of diabetes among patients with active tuberculosis, globally. Heterogeneity (I2) was assessed via the χ2 test on Cochran's Q statistic. This study is registered with PROSPERO, number CRD42016049901. FINDINGS: We screened 7565 records of which 200 studies (2 291 571 people with active tuberculosis) were included in meta-analyses. The pooled prevalence of diabetes was 15·3% (95% prediction interval 2·5-36·1; I2 99·8%), varying from 0·1% in Latvia to 45·2% in Marshall Islands. Subgroup and metaregression analyses for identifying sources of heterogeneity showed that four International Diabetes Federation (IDF) regions (North America and Caribbean [19·7%], western Pacific [19·4%], southeast Asia [19·0%], Middle East and North Africa [17·5%]) had significantly higher prevalence estimates than the three others (Africa [8·0%], South and Central America [7·7%], and Europe [7·5%]; p<0·0001). Additionally, the prevalence increased with age, in men, and in countries with low tuberculosis burden. The prevalence of diabetes was decreased in countries that had low incomes and low Human Development Index scores. The form of tuberculosis infection and presence of HIV seemed not to affect the prevalence of diabetes among patients with active tuberculosis. INTERPRETATION: This study suggests a high burden of diabetes among patients with active tuberculosis, with disparities according to age, sex, regions, level of country income, and development. Cost-effective strategies to curb the burden of diabetes among patients with active tuberculosis are needed. FUNDING: None.

The burden of hypertensive disorders of pregnancy in Africa: A systematic review and meta-analysis.

Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal and perinatal morbidity and mortality, especially in resource-limited settings. Little is known about the magnitude of HDP in Africa. We conducted the first systematic review and meta-analysis to summarize available data on the prevalence of HDP in Africa. We did a comprehensive literature search to identify review paper published from January 1, 1996, to September 30, 2017, and searched the reference list of retrieved review paper. We used a random-effects model to estimate the overall and type-specific prevalence of HDP in Africa. We included 82 studies published between 1997 and 2017 reporting data on a pooled sample of 854 304 women during pregnancy or puerperium. Most studies were hospital-based, conducted in urban settings across 24 countries. In this population, the overall prevalence of HDP was 100.4‰ (95% CI: 81.4-121.2). The prevalence was 49.8‰ (95% CI: 32.3-70.7) for gestational hypertension, 14.7‰ (95% CI: 11.6-18.2) for chronic hypertension, 9.2‰ (95% CI: 4.2-16.0) for superimposed preeclampsia, 44.0‰ (95% CI: 36.7-52.0) for preeclampsia, 22.1‰ (95% CI: 14.8-30.8) for severe preeclampsia, 14.7‰ (95% CI: 8.1-23.2) for eclampsia and 2.2‰ (95% CI: 1.2-3.4) for HELLP syndrome. Prevalence of HDP was significantly higher in Central and Western Africa; there was a consistent tendency of increasing HDP prevalence with income at the country level. In conclusion, the burden of HDP in Africa is high, with about one in 10 pregnancies affected. The higher rate of severe forms of HDP that are associated with significant maternal and perinatal mortality is a major concern in the region.

Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis.

The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6-15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6-16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.