Gender disparity in quality of life in patients with atrial fibrillation during the Syrian conflict: An observational cohort study

Atrial fibrillation screening in Syrian patients reporting to the emergency department during the ongoing conflict: a cross-sectional study

Background

Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding AF screening in conflict countries' emergency departments (ED) is lacking.

Methods

We included consecutive patients >40 years old who reported to the ED of a Syrian tertiary centre between July 2024 and September 2024. Patients had routine 12-lead electrocardiograms (ECGs) regardless of presenting complaints. Two cardiology consultants blindly verified ECG findings. We excluded critically unwell patients and ECG discrepancies between the two consultants. Data were taken from patients' medical notes.

Results

The final analysis included 694 patients, 101 (15%) had AF on the ECG. The most common presenting complaints and ECG abnormality were trauma (44%) and sinus tachycardia (15%), respectively. Compared to the rest of the patients, AF patients were older (66 vs. 59 years; p < 0.001), had a lower proportion of males (39% vs. 54%; p = 0.01), a higher prevalence of diabetes mellitus (49% vs. 21%; p = 0.01), and more cases of congestive cardiac failure (CCF) (38% vs. 17%; p < 0.001). AF patients also had a higher CHA₂DS₂-VASc score (3 vs. 2; p < 0.001). CCF [odds ratio [OR]: 3.3, 95% confidence interval [CI]: 1.5-6.4, p < 0.001] and a higher CHA₂DS₂-VASc score(OR: 4, 95% CI: 1.6-7.7, p < 0.001) were independently associated with positive AF screening.

Conclusion

15% of patients reporting to this Syrian ED had positive AF screening. CCF and CHA₂DS₂-VASc scores are predictive of AF.

Hypertension and Atrial Fibrillation: Bridging the Gap Between Mechanisms, Risk, and Therapy

Background and objectives: Atrial fibrillation (AF), the most prevalent sustained arrhythmia, poses a significant public health challenge due to its links with stroke, heart failure, and mortality. Hypertension, a primary modifiable cardiovascular risk factor, is a well-established risk factor for AF that facilitates structural and electrical changes in the atria, including dilation, fibrosis, and pressure overload. Material and Methods: we conducted a literature search regarding the shared mechanisms, risks and treatments of hypertension and atrial fibrillation. Results: The renin-angiotensin-aldosterone system plays a pivotal role in this remodelling and inflammation, increasing AF susceptibility. Uncontrolled hypertension complicates AF management, diminishing the effectiveness of mainstay treatments, including antiarrhythmic drugs, catheter ablation, and cardioversion. Effective blood pressure management, particularly with therapies targeting the renin-angiotensin-aldosterone system (RAAS), can lower the risk of new-onset AF and reduce the incidence of recurrent AF, enhancing the success of rhythm control strategies. These antihypertensive therapies mitigate myocardial hypertrophy and fibrosis and attenuate both atrial pressure strain and the inflammatory response, mitigating the substrates for AF. Conclusion: This review highlights the urgent need for integrated strategies that combine BP control, AF screening, and lifestyle modifications to minimise the burden of AF and its complications. Future research should investigate the specific mechanisms of cellular-level interactions associated with a hypertensive predisposition to AF, including systematic inflammation and the role of genetics, the impact of blood pressure variations on AF risk, and individualised treatment strategies specifically targeting the shared mechanisms, simultaneously propagating hypertension and AF.

Gender Disparity in Oral Anticoagulation Therapy in Hospitalised Patients with Atrial Fibrillation During the Ongoing Syrian Conflict: Unbalanced Treatment in Turbulent Times

Background: Disparities in the therapy and outcomes of males and females with atrial fibrillation (AF) are known in the developed world. Still, data regarding these disparities in the developing world are scarce. This study explores gender trends and outcomes in oral anticoagulation prescription during the Syrian conflict. Methods: We included adult patients with an index admission with AF to Latakia's tertiary centre between September 2021 and February 2024. Data regarding treatments and comorbidities were taken from patients' medical notes. The composite outcome was a readmission with a cerebrovascular event (CVA) or a bleeding event within 60 days of index discharge. A regression model was used to assess predictors of composite outcomes. Results: A total of 683 consecutive patients admitted and treated for AF satisfied the study criteria, of whom 347 (51%) were females. In patients with a guideline indication for anticoagulation (n = 553), males were prescribed more DOACs and fewer VKAs than females (93% versus 71%, p < 0.001 and 7% versus 29%, p = 0.01, respectively). Composite outcomes occurred significantly more in females than males (16% versus 6%, p = 0.03). Females on VKAs had significantly more composite outcomes than males (70% versus 53%, p < 0.001). Independent predictors of composite outcomes included females compared to males (hazard ratio [HR]: 2.3 and 6.2, 95% confidence interval [CI]: 1.3-4.2 and 3.7-10.8, p = 0.001 and <0.001) and VKAs compared to direct oral anticoagulants (DOACs) (HR: 8.4, 95%CI: 4.8-15.3, p < 0.001). Conclusions: Females at this Syrian centre had a higher use of VKAs and a lower use of DOACs compared to males, resulting in a higher rate of composite outcomes of CVA and bleeding events.