Abstract
<title>Abstract</title> <p>Background Atrial fibrillation (AFIB) increases stroke risk three- to fivefold and is associated with severe neurological deficits and higher mortality. In Sub-Saharan Africa, reliance on resting electrocardiography underestimates paroxysmal AFIB burden. This study determined AFIB prevalence, associated factors, and clinical outcomes among acute stroke patients in Mwanza, Tanzania. Methods A hospital-based cross-sectional study with prospective follow-up was conducted among 200 adults with neuroimaging-confirmed acute stroke at two hospitals in Mwanza, Tanzania, between November 2025 and June 2026. AFIB was assessed using 12-lead ECG and 24-hour Holter monitoring. Multivariate logistic regression identified independent predictors. Survival was assessed using Kaplan-Meier analysis. Results AFIB prevalence was 29.5% (59/200) and among these 54.2% (32/59) were further picked by holter ECG. Independent predictors were age > 65 years (aOR 3.94, 95% CI 1.48–10.49; p = 0.006), left ventricular hypertrophy (aOR 7.29, 95% CI 1.86–28.57; p = 0.004), left atrial dilatation (aOR 8.11, 95% CI 2.28–28.84; p = 0.001), hyponatremia (aOR 5.45, 95% CI 1.75–17.01; p = 0.003), hyperglycemia (aOR 4.20, 95% CI 1.43–12.39; p = 0.009), hypertriglyceridemia (aOR 3.90, 95% CI 1.09–13.92; p = 0.036), cardiac ischemia (aOR 3.33, 95% CI 1.14–9.74; p = 0.028), and hypertension (aOR 7.01, 95% CI 1.44–34.19; p = 0.016). Hemorrhagic stroke was protective (aOR 0.21, 95% CI 0.08–0.58; p = 0.002). AFIB patients had higher in-hospital mortality (45.8% vs. 29.1%; p = 0.003), longer hospital stays (> 7 days: 45.8% vs. 28.4%; p = 0.030), and lower survival on Kaplan-Meier analysis. Conclusions Atrial fibrillation is highly prevalent among acute stroke patients in Tanzania and is independently associated with adverse outcomes. Integration of Holter ECG screening into acute stroke care in resource-limited settings should be prioritized to improve detection, guide anticoagulation, and reduce stroke-related disparities.</p>