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Antoun I, Aljabal M, Alkhayer A, Mahfoud Y, Alkhayer A, Simon P, Kotb A, Barker J, Mavilakandy A, Naseer MU, Somani R, Ng GA, Zakkar M. Atrial fibrillation inpatient management patterns and clinical outcomes during the conflict in Syria: An observational cohort study. Perfusion 2024:2676591241259140. [PMID: 38830625 DOI: 10.1177/02676591241259140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there is no data on AF inpatient management strategies and clinical outcomes in Syria. OBJECTIVES The study aims were to review the inpatient management of patients with AF and assess cardiovascular (CV) mortality in a tertiary cardiology centre in Latakia, Syria. METHODS A single-centre retrospective observational cohort study was conducted at Tishreen's University Hospital, Latakia, Syria, from June 2021 to June 2023. Patients ≥16 years of age presenting and being treated for AF as the primary diagnosis with or without a thromboembolic event were included. Medical records were examined for patients' demographics, laboratory results, treatment plans and inpatient details. Studied outcomes include inpatient all-cause and CV mortality, ischemic and bleeding events, and conversion to sinus rhythm (SR). RESULTS The study included 596 patients. The median age was 58, and 61% were males. 121 patients (20.3%) were known to have AF. A rhythm control strategy was pursued in 39% of patients. Ischemic and bleeding events occurred in 62 (11%) and 12 (2%), respectively. CV and all-cause mortality occurred in 28 (4.7%) and 31 patients (5%), respectively. The presence of valvular heart disease (VHD) (adjusted odds ratio (aOR) = 9.1, 95% confidence interval (CI): 1.7 to 55.1, p < .001), thyroid disease (aOR: 9.7, 95% CI = 1.2 to 91.6, p < .001) and chronic obstructive pulmonary disease (COPD) (aOR: 82, 95% CI: 12.7 to 71, p < .001) were independent risk factors of increased CV inpatient mortality. CONCLUSION Syrian inpatients admitted with AF in Latakia are relatively younger than those in other countries. Active thyroid disease, COPD and VHD were independent risk factors of inpatient CV mortality with AF.
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Affiliation(s)
- Ibrahim Antoun
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Majed Aljabal
- Department of Psychiatry, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Alkassem Alkhayer
- Department of Medicine, University of Tishreen's Hospital, Latakia, Syria
| | - Yaman Mahfoud
- Department of Medicine, University of Tishreen's Hospital, Latakia, Syria
| | - Alamer Alkhayer
- Department of Medicine, University of Tishreen's Hospital, Latakia, Syria
| | - Peter Simon
- Department of Medicine, University of Tishreen's Hospital, Latakia, Syria
| | - Ahmed Kotb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Joseph Barker
- Department of Research, National Heart and Lung Institute, Imperial College London, London, UK
| | - Akash Mavilakandy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Muhammad Usman Naseer
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Riyaz Somani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - G André Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
- Faculty of Medicine, University of Damascus, Damascus, Syria
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Qafoud F, Elshrif M, Kunji K, Althani A, Salam A, Al Suwaidi J, Asaad N, Darbar D, Saad M. Genetic Susceptibility to Arrhythmia Phenotypes in a Middle Eastern Cohort of 14,259 Whole-Genome Sequenced Individuals. J Clin Med 2024; 13:1102. [PMID: 38398418 PMCID: PMC10888535 DOI: 10.3390/jcm13041102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The current study explores the genetic underpinnings of cardiac arrhythmia phenotypes within Middle Eastern populations, which are under-represented in genomic medicine research. Methods: Whole-genome sequencing data from 14,259 individuals from the Qatar Biobank were used and contained 47.8% of Arab ancestry, 18.4% of South Asian ancestry, and 4.6% of African ancestry. The frequency of rare functional variants within a set of 410 candidate genes for cardiac arrhythmias was assessed. Polygenic risk score (PRS) performance for atrial fibrillation (AF) prediction was evaluated. Results: This study identified 1196 rare functional variants, including 162 previously linked to arrhythmia phenotypes, with varying frequencies across Arab, South Asian, and African ancestries. Of these, 137 variants met the pathogenic or likely pathogenic (P/LP) criteria according to ACMG guidelines. Of these, 91 were in ACMG actionable genes and were present in 1030 individuals (~7%). Ten P/LP variants showed significant associations with atrial fibrillation p < 2.4 × 10-10. Five out of ten existing PRSs were significantly associated with AF (e.g., PGS000727, p = 0.03, OR = 1.43 [1.03, 1.97]). Conclusions: Our study is the largest to study the genetic predisposition to arrhythmia phenotypes in the Middle East using whole-genome sequence data. It underscores the importance of including diverse populations in genomic investigations to elucidate the genetic landscape of cardiac arrhythmias and mitigate health disparities in genomic medicine.
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Affiliation(s)
- Fatima Qafoud
- College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar; (F.Q.); (A.A.)
| | - Mohamed Elshrif
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha P.O. Box 5825, Qatar; (M.E.); (K.K.)
| | - Khalid Kunji
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha P.O. Box 5825, Qatar; (M.E.); (K.K.)
| | - Asma Althani
- College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar; (F.Q.); (A.A.)
| | - Amar Salam
- Department of Cardiology, Al-Khor Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Jassim Al Suwaidi
- Heart Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (J.A.S.); (N.A.)
| | - Nidal Asaad
- Heart Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (J.A.S.); (N.A.)
| | - Dawood Darbar
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Mohamad Saad
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha P.O. Box 5825, Qatar; (M.E.); (K.K.)
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3
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Patel J, Bhaskar SMM. Diagnosis and Management of Atrial Fibrillation in Acute Ischemic Stroke in the Setting of Reperfusion Therapy: Insights and Strategies for Optimized Care. J Cardiovasc Dev Dis 2023; 10:458. [PMID: 37998516 PMCID: PMC10672610 DOI: 10.3390/jcdd10110458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Reperfusion therapy in the form of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) has revolutionised the field of stroke medicine. Atrial fibrillation (AF) patients constitute a major portion of the overall stroke population; however, the prevalence of AF amongst acute ischemic stroke (AIS) patients receiving reperfusion therapy remains unclear. Limitations in our understanding of prevalence in this group of patients are exacerbated by difficulties in appropriately diagnosing AF. Additionally, the benefits of reperfusion therapy are not consistent across all subgroups of AIS patients. More specifically, AIS patients with AF often tend to have poor prognoses despite treatment relative to those without AF. This article aims to present an overview of the diagnostic and therapeutic management of AF and how it mediates outcomes following stroke, most specifically in AIS patients treated with reperfusion therapy. We provide unique insights into AF prevalence and outcomes that could allow healthcare professionals to optimise the treatment and prognosis for AIS patients with AF. Specific indications on acute neurovascular management and secondary stroke prevention in AIS patients with AF are also discussed.
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Affiliation(s)
- Jay Patel
- Global Health Neurology Lab, Sydney 2150, Australia
- South Western Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales (UNSW), Sydney 2170, Australia
- Ingham Institute for Applied Medical Research, Neurovascular Imaging Laboratory, Clinical Sciences Stream, Sydney 2170, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology Lab, Sydney 2150, Australia
- Ingham Institute for Applied Medical Research, Neurovascular Imaging Laboratory, Clinical Sciences Stream, Sydney 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney 2170, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital, South Western Sydney Local Health District (SWSLHD), Sydney 2170, Australia
- Department of Neurology, National Cerebral and Cardiovascular Center (NCVC), Suita 564-8565, Osaka, Japan
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4
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Patel J, Bhaskar SMM. Atrial Fibrillation and Reperfusion Therapy in Acute Ischaemic Stroke Patients: Prevalence and Outcomes-A Comprehensive Systematic Review and Meta-Analysis. Neurol Int 2023; 15:1014-1043. [PMID: 37755356 PMCID: PMC10537209 DOI: 10.3390/neurolint15030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Atrial fibrillation (AF) significantly contributes to acute ischaemic stroke (AIS), yet its precise influence on clinical outcomes post-intravenous thrombolysis (IVT) and post-endovascular thrombectomy (EVT) has remained elusive. Furthermore, the overall prevalence of AF in AIS patients undergoing reperfusion therapy has not been clearly determined. Employing random-effects meta-analyses, this research aimed to estimate the pooled prevalence of AF among AIS patients undergoing reperfusion therapy, while also examining the association between AF and clinical outcomes such as functional outcomes, symptomatic intracerebral haemorrhage (sICH) and mortality. Studies comparing AF and non-AF patient groups undergoing reperfusion therapy were identified and included following an extensive database search. Forty-nine studies (n = 66,887) were included. Among IVT patients, the prevalence of AF was 31% (Effect Size [ES] 0.31 [95%CI 0.28-0.35], p < 0.01), while in EVT patients, it reached 42% (ES 0.42 [95%CI 0.38-0.46], p < 0.01), and in bridging therapy (BT) patients, it stood at 36% (ES 0.36 [95%CI 0.28-0.43], p < 0.01). AF was associated with significantly lower odds of favourable 90-day functional outcomes post IVT (Odds Ratio [OR] 0.512 [95%CI 0.376-0.696], p < 0.001), but not post EVT (OR 0.826 [95%CI 0.651-1.049], p = 0.117). Our comprehensive meta-analysis highlights the varying prevalence of AF among different reperfusion therapies and its differential impact on patient outcomes. The highest pooled prevalence of AF was observed in EVT patients, followed by BT and IVT patients. Interestingly, our analysis revealed that AF was significantly associated with poorer clinical outcomes following IVT. Such an association was not observed following EVT.
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Affiliation(s)
- Jay Patel
- Global Health Neurology Lab., Sydney, NSW 2150, Australia
- South Western Sydney Clinical Campuses, University of New South Wales (UNSW) Medicine and Health, UNSW Sydney, Sydney, NSW 2170, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology Lab., Sydney, NSW 2150, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital & South Western Sydney Local Health District (SWSLHD), Sydney, NSW 2170, Australia
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5
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Hewage S, Jadamba A, Brain D, Parsonage W, McPhail S, Kularatna S. Global and regional burden of ischemic stroke associated with atrial fibrillation, 2009-2019. Prev Med 2023; 173:107584. [PMID: 37348767 DOI: 10.1016/j.ypmed.2023.107584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/27/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
The extent of the preventable burden of ischaemic stroke associated with atrial fibrillation (AF) remains uncertain to date. To address this knowledge gap, we utilised the comparative risk assessment methodology to estimate the burden of ischaemic stroke associated with AF at both global and regional levels. The population attributable fraction for ischaemic stroke and AF was obtained from published literature, while data on the prevalence, incidence, deaths, and disability-adjusted life years (DALY) associated with ischaemic stroke were sourced from the Global Burden of Disease study database. Our analysis revealed that in 2019, globally, there were an estimated 0.7 (95% uncertainty interval [UI] of 0.55 to 0.83) million incident cases, 6.9 (5.81 to 8.12) million prevalence cases, 0.3 0.25 to 0.34) million deaths and 5.7 (4.91 to 6.57) million DALY resulting from ischaemic stroke associated with AF. The age-standardised death and DALY rates declined between 2009 and 2019 in all regions to varying degrees. Conversely, the age-standardised incidence and prevalence rates reduced only in high-income countries, Central Europe, Eastern Europe and Central Asia and Latin America and Caribbean regions. It is likely that our findings under-estimated the true burden of ischaemic stroke associated with AF due to limitations such as the use of a fixed population attributable fraction and poor quality of data. Nevertheless, we believe that our estimates provide valuable insights and highlight the urgent need for optimised management of AF through the implementation of efficacious interventions. Such efforts can help reduce the occurrence of preventable ischaemic strokes.
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Affiliation(s)
- Sumudu Hewage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia.
| | - Amarzaya Jadamba
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Cardiology Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Digital Health and Informatics Directorate, Metro South Health, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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6
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Bhat A, Karthikeyan S, Chen HHL, Gan GCH, Denniss AR, Tan TC. BARRIERS TO GUIDELINE-DIRECTED ANTICOAGULATION IN PATIENTS WITH ATRIAL FIBRILLATION NEW APPROACHES TO AN OLD PROBLEM. Can J Cardiol 2023; 39:625-636. [PMID: 36716858 DOI: 10.1016/j.cjca.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 01/22/2023] [Accepted: 01/22/2023] [Indexed: 01/29/2023] Open
Abstract
Optimising guideline-directed anticoagulation in atrial fibrillation remains a perennial problem despite strong evidence for improved health outcomes with use of guideline-directed anticoagulation. Efforts to improve uptake have been hampered by barriers found at the level of the physician, patient, disease and choices of therapy. Clinician judgement is often clouded by factors such as therapeutic inertia, aversion to bleeding risk and implicit bias. For patients, negative pre-conceptions of therapy, impact of therapy on day-to-day life and the nocebo effect pose significant barriers. Both groups are impacted by poor education. Utility of a single pronged approach directed towards clinicians or patients have demonstrated variable success, with the highest impact appreciated in studies employing shared decision models. Further, there is emerging evidence for use of integrated models of care, which have shown improved efficacy in improving patient outcomes, as well as use of digital platforms such as mobile app-based interventions, which can be of aid to the clinician in improving patient adherence to anticoagulation with translated improved outcomes in clinical trials. Our narrative review article aims to investigate the physician and health system, patient, as well as drug therapy and disease barriers to uptake of guideline-directed anticoagulation in treatment of non-valvular atrial fibrillation.
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Affiliation(s)
- Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia.
| | - Sowmiya Karthikeyan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia
| | - A Robert Denniss
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia; School of Medicine, Western Sydney University, Sydney, NSW 2148, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW 2145, Australia
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7
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Li H, Song X, Liang Y, Bai X, Liu-Huo WS, Tang C, Chen W, Zhao L. Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990-2019: results from a global burden of disease study, 2019. BMC Public Health 2022; 22:2015. [PMID: 36329400 PMCID: PMC9632152 DOI: 10.1186/s12889-022-14403-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background Data from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019) was used to assess the burden and change in prevalence, incidence, deaths, disability-adjusted life years, and risk factors for atrial fibrillation/flutter in 204 countries and territories between 1990 and 2019. Methods Incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their age-standardized rates of AF/AFL were analyzed by age, sex, socio-demographic index (SDI), and human development index (HDI) using the Global Burden of Disease study 2019 (GBD2019) results,and risk factors for AF/AFL (mainly high systolic blood pressure, high body-mass index, alcohol use, smoking and diet high in sodium) were differentially analyzed. Results There are 59.70 million (95% uncertainty interval (UI) 45.73–75.29 million) AF/AFL patients worldwide in 2019, with 4.72 million (95% uncertainty interval (UI) 3.64–5.96 million) new cases and 0.315 million deaths (95% uncertainty interval (UI) 0.268–0.361 million) and 8.39 million disability-adjusted years (95% uncertainty interval (UI) 6.69–10.54 million). The highest risk factor for deaths, DALYs attributable to AF/AFL in 2019 was high systolic blood pressure, high body-mass index, alcohol use, smoking, and diet high in sodium. It is estimated that between 2030 and 2034, the total incidence of male AF/ AFL will be 16.08 million, and the total number of deaths will be 1.01 million. For females, the total number of incidence is 16.85 million, and the total number of deaths is 1.49 million. Conclusions AF/AFL remains a major global public health problem, although the ASR of prevalence, incidence, and DALY at the worldwide level showed a decreasing trend from 1990 to 2019(the ASR of deaths increased slightly). However, the unfavorable trend observed in this study in countries with lower SDI suggests that current prevention and treatment strategies should be reoriented. Some countries should develop more targeted and specific strategies to prevent the increase of AF/AFL. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14403-2.
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Affiliation(s)
- Hong Li
- grid.410578.f0000 0001 1114 4286Southwest Medical University, Lu Zhou, China
| | - Xuejing Song
- grid.410578.f0000 0001 1114 4286Southwest Medical University, Lu Zhou, China
| | - Yi Liang
- grid.410578.f0000 0001 1114 4286Southwest Medical University, Lu Zhou, China
| | - Xue Bai
- grid.488387.8The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
| | - Wu-Sha Liu-Huo
- grid.488387.8The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
| | - Chao Tang
- grid.488387.8The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
| | - Wen Chen
- grid.410578.f0000 0001 1114 4286Southwest Medical University, Lu Zhou, China
| | - Lizhi Zhao
- grid.488387.8The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Lu Zhou, China
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8
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Raad M, Lewis C, Almajed MR, Makki T, Refaat M, Khan A, Lahiri M. Atrial fibrillation prevalence and management patterns in a Middle Eastern community in the United States: A retrospective study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 23:100221. [PMID: 38560655 PMCID: PMC10978395 DOI: 10.1016/j.ahjo.2022.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 04/04/2024]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia in the United States, and its prevalence is expected to increase along with associated morbidity and economic burden. Prior research has demonstrated differing prevalence patterns of AF between racial and ethnic groups, with lower rates identified in Black patients. However, to date there have been no studies on AF prevalence in people of Middle Eastern descent within the United States. This retrospective cross-sectional study aimed to characterize prevalence patterns of AF in Middle Eastern patients in Southeast Michigan relative to White and Black patients. The final cohort included 919,454 patients with a median (IQR) age of 53 (33) years (515,902 [56 %] female). The overall prevalence of AF was approximately 5 %. We observed a lower prevalence of AF in Middle Eastern (2.8 %) and Black patients (3.4 %) than in White patients (6.5 %). Middle Eastern patients with AF were younger with a lower prevalence of cardiovascular risk factors than White patients. Multivariable analysis showed that Middle Eastern (OR 0.75; 95 % CI 0.71-0.80; P < 0.001) and Black racial identity (OR 0.48; 95 % CI 9.47-0.49; P < 0.001) were associated with a lower odds of AF, even after adjustment for traditional risk factors.
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Affiliation(s)
- Mohamad Raad
- Section of Electrophysiology, Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Christopher Lewis
- Section of Electrophysiology, Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Tarek Makki
- Section of Electrophysiology, Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Marwan Refaat
- Division of Electrophysiology, Department of Cardiology, American University of Beirut, Beirut, Lebanon
| | - Arfaat Khan
- Section of Electrophysiology, Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Marc Lahiri
- Section of Electrophysiology, Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
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Jarrah MI, Alrabadi N, Alzoubi KH, Mhaidat QN, Hammoudeh A. Is there a Concordance between CHA2DS2 VASc and HAS-BLED Scores in Middle Eastern Patients with Nonvalvular AF? Analysis of the Jordan Atrial Fibrillation (JoFib) Study. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2203290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Nonvalvular Atrial Fibrillation (NVAF) is a common arrhythmia that potentially contributes to stroke and systemic embolization. Anticoagulants may contribute to the risk of bleeding in these patients. Reports of NVAF on Middle Eastern populations are scarce and outdated. This study investigated the concordance between congestive heart failure, hypertension, ≥75 years of age, diabetes mellitus, stroke or transient ischemic attack, vascular disease, 65 to 74 years of age group, sex category (CHA2DS2 VASc), and Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) scores, and the risks of stroke and bleeding in Jordanian NVAF patients.
Methods:
Results were extracted from the Jordan Atrial Fibrillation (JoFib) multicenter registry (NCT03917992). To assess the risk of stroke, a CHA2DS2 VASc score was used. The HAS-BLED score was used to assess the risk of bleeding. Subgroup analysis for males and females was carried out.
Results:
We included 1823 NVAF patients, almost equally distributed among males and females. The overall mean age was 68.2 years. Most patients had a body mass index (BMI) ≥ 25 (71.5%). Almost half of the patients were smokers, 45.5% had diabetes, and 76.3% had hypertension. Paroxysmal AF was the most common subtype (38%), followed by the permanent (28.6%), long-standing (17.3%), and persistent types (16.1%). Females had a significantly higher CHA2DS2 VASc score than males (p=0.012). For the risk of bleeding, 48.9% of patients had a low risk, 31.5% had intermediate risk, and 19.6% had a high risk. A correlation was found between the two scoring systems. Out of the 357 patients who had a high HAS-BLED score, 354 (99.2%) patients also had a high CHA2DS2 VASc score.
Conclusion:
In almost all NVAF patients with a high risk of bleeding (high HAS-BLED score), the use of anticoagulants is highly recommended and strongly indicated according to the CHA2DS2 VASc score stratification. Therefore, strict strategies of well-controlled administration of anticoagulants should always be considered and followed in Middle Eastern patients with NVAF and a high risk of bleeding.
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10
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One-Year Clinical Outcome in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study. Int J Vasc Med 2022; 2022:4240999. [PMID: 35462945 PMCID: PMC9020983 DOI: 10.1155/2022/4240999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/12/2022] Open
Abstract
Background. Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fibrillation (AF) has radically changed in recent years. Data on contemporary utilization of oral anticoagulants (OACs) and cardiovascular outcome in Middle Eastern patients with AF are needed. Methods. The Jordan atrial fibrillation (JoFib) study enrolled consecutive patients with AF in Jordan from May 2019 through October 2020 and were followed up for one year after enrollment. Results. Overall, 2020 patients were enrolled. The mean age was
years. Nonvalvular (NVAF) was diagnosed in 1849 (91.5%) patients. OACs were used in 85.7% of high-risk patients with NVAF (CHA2DS2-VASc score>3 in women, and>2 in men), including direct OACs (DOACs) in 64.1% and vitamin K antagonists (VKA) in 35.9%. Adherence rate to the use of the same OAC agent was 90.6% of patients. One-year cardiovascular (CV) mortality was 7.8%, stroke/SE was 4.5%, and major bleeding events were 2.6%. Independent predictors for all-cause mortality in patients with NVAF were age>75 years, heart failure, major bleeding event, type 2 diabetes mellitus, study enrollment as an in-patient, and coronary heart disease. The use of OACs was associated with lower all-cause mortality. The strongest independent predictors for stroke/SE were high-risk CHA2DS2-VASc score and prior history of stroke. Conclusions. This study of Middle Eastern AF patients has reported high adherence to OACs. The use of OACs was associated with a lower risk for all-cause mortality. One-year rates of stroke and major bleeding events were comparable to those reported from other regions in the world.
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Al-Makhamreh H, Al-Ani A, Alkhulaifat D, Shaban L, Salah N, Almarayaty R, Al-Huneidy Y, Hammoudeh A. Impact of thyroid disease in patients with atrial fibrillation: Analysis from the JoFib registry. Ann Med Surg (Lond) 2022; 74:103325. [PMID: 35145683 PMCID: PMC8818533 DOI: 10.1016/j.amsu.2022.103325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Thyroid disease is a well-established risk factor for atrial fibrillation (AF). However, only a handful of studies examined its impact on treatment. This study aims to report the prevalence rate of thyroid disease in patients with AF and to demonstrate the effect of thyroid disease on AF treatment. Materials and methods We retrospectively analyzed the Jordanian Atrial Fibrillation Study (JoFib). Among Jordan and Palestine, patients with AF were evaluated for their sociodemographic, clinical, and pharmacological characteristics. Results A total of 2000 patients with AF (53.3% males, mean age 67.6 ± 13.1 years) were enrolled in the JoFib registry from May 2019 to November 2020. Thyroid disease was present in 210 (10.5%) patients. Hypertension, diabetes mellitus, and dyslipidemia were the most common comorbidities among patients with thyroid history (75.2%, 51.0%, and 45.7%, respectively). Diabetes mellitus (p = .04), pulmonary hypertension (p = .01), and chronic kidney disease (p = .01) were significantly higher in this particular subgroup. Patients with thyroid disease demonstrated significantly higher usage of anticoagulants (p = .02). Conclusion Despite having similar stroke and bleeding risks, patients with thyroid disease demonstrated meaningful differences in their baseline characteristics. Prospective studies are required to assess the influence of thyroid hormone fluctuations on the progression of AF. Thyroid disease doesn't appear to impact bleeding risk in atrial fibrillation. Patients with thyroid disease are more likely to consume more anticoagulants. Thyroid disease in atrial fibrillation maybe linked with pulmonary hypertension. Assessment tools of stork or bleeding may be underestimated in Arab Jordanians.
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Affiliation(s)
- Hanna Al-Makhamreh
- Department of Internal Medicine, Division of Cardiology, Jordanian University Hospital, Amman, 11185, Jordan
- University of Jordan, School of Medicine, Amman, 11185, Jordan
| | - Abdallah Al-Ani
- University of Jordan, School of Medicine, Amman, 11185, Jordan
- Corresponding author. University of Jordan, School of Medicine, Jordan.
| | | | - Liza Shaban
- University of Jordan, School of Medicine, Amman, 11185, Jordan
| | - Neveen Salah
- University of Jordan, School of Medicine, Amman, 11185, Jordan
| | | | | | - Ayman Hammoudeh
- Department of Cardiology, Istishari Hospital, Amman, 11185, Jordan
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Sayin BY, Al Mahmeed W, Ragy HI, Elbahry A, Virdone S, Kakkar AK, Ersanlı M, Oto A. Middle East Treatment Strategies and Clinical Outcomes in Patients with Atrial Fibrillation: One-Year Follow-up Data from Garfield-AF Study. Adv Ther 2021; 38:2391-2405. [PMID: 33772428 DOI: 10.1007/s12325-021-01670-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/13/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) aims to determine real-life treatment patterns and clinical outcomes of patients with newly diagnosed non-valvular atrial fibrillation (AF) and at least one investigator-determined risk factor for stroke. The registry includes a wide array of baseline characteristics and has a particular focus on: (1) bleeding and thromboembolic events; (2) international normalized ratio fluctuations; and (3) therapy compliance and persistence patterns. METHODS Evolution in baseline treatment for patients enrolled in sequential cohorts showed an increase in prescribing of novel oral anticoagulants over time. Variability in novel oral anticoagulant prescription is primarily due to differences in availability of treatment and prescribing habits between countries and care settings. The GARFIELD-AF registry also provides insights into clinical management and related outcomes of AF in Middle East populations. RESULTS A total of 1660 patients with non-valvular AF (median age 64.0 years, interquartile range 56.0-72.0), mostly diagnosed in cardiology settings from Egypt, the United Arab Emirates and Turkey, were recruited in cohorts 3-5. Data from patient populations in the Middle East related to the rates of stroke/systemic embolism, major bleeding and all-cause mortality 1 year after diagnosis of AF and treatment strategies, based on the stroke and bleeding risk, have been analysed and compared with the rest of the world. The use of antithrombotic treatment in the Middle East was generally higher than the non-Middle East, with increased prescription of antiplatelet therapy (AP) therapy. Appropriate use of Factor Xa inhibitors/direct thrombin inhibitors (DTIs) were 74.4% and Factor Xa/DTI + APs were 70.4% in the overall population, whereas they were 57.1% and 63.6%, respectively, in the Middle East. CONCLUSION We have found that rates of stroke and bleeding were lower, although mortality was higher, in the Middle East population. This paper describes the baseline characteristics, patterns of antithrombotic treatment and 1-year outcomes in Middle East AF patients. TRIAL REGISTRATION http://www.clinicaltrials.gov . Identifier, NCT01090362.
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Affiliation(s)
| | - Wael Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | | | - Atef Elbahry
- Cardiology Unit, Port Fouad Centre, Port Fouad, Egypt
| | | | - Ajay K Kakkar
- Department of Clinical Research, Thrombosis Research Institute (TRI), London, UK
| | - Murat Ersanlı
- Department of Cardiology, Institute of Cardiology, Istanbul University, Istanbul, Turkey
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
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13
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Azar RR, Ragy HI, Kozan O, El Khuri M, Bazergani N, Marler S, Teutsch C, Ibrahim M, Lip GY, Huisman MV. Antithrombotic treatment pattern in newly diagnosed atrial fibrillation patients and 2-year follow-up results for dabigatran-treated patients in the Africa/Middle-East Region: Phase II results from the GLORIA-AF registry program. IJC HEART & VASCULATURE 2021; 34:100763. [PMID: 33912651 PMCID: PMC8065192 DOI: 10.1016/j.ijcha.2021.100763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/19/2022]
Abstract
Background Data on the epidemiology and treatment of atrial fibrillation in the Africa/Middle East region are limited, and the use of novel oral anticoagulants and their effectiveness in real-world clinical practice has not been evaluated. Methods and Results This study used prospectively collected data from the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation (GLORIA-AF) to describe anticoagulant use and outcomes in Africa and the Middle East. Baseline characteristics of patients newly diagnosed with nonvalvular atrial fibrillation from Lebanon (242 patients, 40.3%), Saudi Arabia (236 patients, 39.3%), United Arab Emirates (87 patients, 14.5%), and South Africa (35 patients, 5.8%) were described, and clinical outcomes were investigated for all patients in this region who received dabigatran. In newly diagnosed patients (having a diagnosis within the last three months) with nonvalvular atrial fibrillation in Africa and the Middle East, the observed uptake of non-vitamin K oral anticoagulants was high in the first years following their availability; dabigatran was the most commonly used antithrombotic agent (314/600 patients), and only 1.5% of patients did not receive any antithrombotic therapy. Use of dabigatran was associated with a high persistence rate (>88% at 24 months) and low incidence rates of stroke, myocardial infarction, major bleeding, and all-cause mortality after 2 years of follow-up. Conclusions Data from GLORIA-AF reveal a change in the landscape for stroke prevention in the AME region, and the results were consistent with those observed in the global GLORIA-AF registry, as well as those of randomized clinical trials. Clinical Trial Registration: NCT01937377 (https://clinicaltrials.gov/ct2/show/NCT01937377).
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Affiliation(s)
- Rabih R. Azar
- Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
- Corresponding author at: Division of Cardiology, Hotel Dieu de France Hospital, Beirut, Lebanon.
| | | | - Omer Kozan
- Başkent University Medical Faculty, Istanbul, Turkey
| | | | | | | | - Christine Teutsch
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Mohamed Ibrahim
- Boehringer Ingelheim Middle East & North Africa FZ-Ltd, Dubai, United Arab Emirates
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, Liverpool, UK
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Hammoudeh AJ, Khader Y, Kadri N, Al-Mousa E, Badaineh Y, Habahbeh L, Tabbalat R, Janabi H, Alhaddad IA. Adherence to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline on the Use of Oral Anticoagulant Agents in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study. Int J Vasc Med 2021; 2021:5515089. [PMID: 33898065 PMCID: PMC8052172 DOI: 10.1155/2021/5515089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a scarcity of studies that evaluate adherence to the utilization of guideline-recommended oral anticoagulant agents (OACs) in patients with atrial fibrillation (AF) in the Middle East. The Jordan Atrial Fibrillation (JoFib) Study evaluated baseline clinical profiles and the utilization of OACs, including vitamin K antagonists (VKAs) and direct OACs (DOACs), in patients with valvular AF (VAF) and nonvalvular AF (NVAF) according to the 2019 focused update of the 2014 AHA/ACC/HRS guidelines. METHODS Consecutive patients with AF were enrolled in 29 hospitals and outpatient clinics. The use of OACs was evaluated in patients with VAF and NVAF according to the prespecified guideline. RESULTS Of 2000 patients, 177 (8.9%) had VAF and 1823 (91.1%) had NVAF. A VKA was prescribed for 88.1% of the VAF group. In the NVAF group, 1468 (80.5%) of patients had a high CHA2DS2-VASc score, i.e., a score of ≥3 in women and ≥2 in men; 202 (11.1%) patients had an intermediate CHA2DS2-VASc score, i.e., a score of 2 in women and 1 in men; and 153 (8.4%) patients had a low CHA2DS2-VASc score, i.e., a score of 1 in women and 0 in men. Of patients with a high CHA2DS2-VASc score, 1204 (82.0%) received OACs, including DOACs for 784 (53.4%) and VKA for 420 (28.6%) patients. Among patients with an intermediate score, OACs were prescribed for 148 (73.3%) patients, including 107 (53.0%) who received DOACs and 41 (20.3%) patients who received VKA. In patients with a low score, OACs were omitted in 94 (61.4%) patients and prescribed for 59 (38.6%) patients. Multivariate analysis showed that age between 50 and 70 years, CHA2DS2-VASc score of ≥2, a diagnosis of stroke or systemic embolization, and nonparoxysmal AF were significantly associated with increased odds of OAC prescription. CONCLUSIONS The current status of the utilization of OACs in Middle Eastern AF patients appears to be promising and is consistent with the 2019 focused update of the 2014 AHA/ACC/HRS guideline. This trial is registered with NCT03917992.
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Affiliation(s)
- Ayman J. Hammoudeh
- Cardiology Department, Istishari Hospital, 44 Kindi Street Amman 11184, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology School of Medicine, 3030 Ramtha Street, P.O. Box 3030, Irbid 22110, Jordan
| | - Nazih Kadri
- Electrophysiology and General Cardiology Sections, Cardiology Department, Abdali Hospital, 1 Al-Istethmar Street, Abdali Boulevard, Amman 11190, Jordan
| | - Eyas Al-Mousa
- Cardiology Department, Istishari Hospital, 44 Kindi Street Amman 11184, Jordan
| | - Yahya Badaineh
- Cardiology Department, Istishari Hospital, 44 Kindi Street Amman 11184, Jordan
| | - Laith Habahbeh
- Cardiology Department, Istishari Hospital, 44 Kindi Street Amman 11184, Jordan
| | - Ramzi Tabbalat
- Electrophysiology and General Cardiology Sections, Cardiology Department, Abdali Hospital, 1 Al-Istethmar Street, Abdali Boulevard, Amman 11190, Jordan
| | - Hesham Janabi
- Intensive Care Unit, Istishari Hospital, 44 Kindi Street, Amman 11184, Jordan
| | - Imad A. Alhaddad
- Cardiology Department, Aqaba Isl Hospital, 15 Sharif Shaker Ben Zaidstreet, Aqaba 77110, Jordan
- Cardiology Department, Jordan Hospital, 9 Nuzha Street, Amman 11196, Jordan
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15
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Akiki D, El Hage S, Wakim E, Safi S, Assouad E, Salameh P. Atrial Fibrillation in the Arab World: A Bibliometric Analysis of Research Activity from 2004 to 2019. JOURNAL OF CARDIAC ARRHYTHMIAS 2021. [DOI: 10.24207/jca.v34i1.3430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Atrial fibrillation (AF) is in an increasing pattern worldwide, especially in the Arab world. Objective: The aim of this article is to assess AF research activity in the Arab countries over the past 16 years, taking into consideration the population size, gross domestic product (GDP) and disability-adjusted life years (DALY). Methods: Atrial fibrillation related research articles published from Arab countries between 2004 and 2019 were collected from the MEDLINE database and are cited online on PubMed. Medical Subject Heading (MeSH) terms related to the subject, the origin and the date of publication were used to search for the published articles. Results: The number of AF related publications in the Arab world over the past 16 years was only 283 (0.73%) out of a total of 38,983 publications worldwide. Saudi Arabia ranked first in terms of number of AF related publications, followed by Egypt. Lebanon is the country with the highest number of publications per USD billion GDP, while Egypt and Saudi Arabia have the highest number of publications per 1% DALYs. According to the population size, Qatar and Bahrain produced the highest number of publications per million persons (PPMP). A strong and positive correlation was found between the number of publications and the GDP. The population size and the percentage of DALY showed positive yet weak correlation. Conclusion: A slight increase in AF related publications is observed. Nonetheless, AF research activity in the Arab world is still insufficient.
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Affiliation(s)
- Dany Akiki
- Lebanese University – Faculty of Medical Sciences –Department of Internal Medicine – Hadath – Lebanon
| | - Said El Hage
- Lebanese University – Faculty of Medical Sciences –Department of Internal Medicine – Hadath – Lebanon
| | - Elias Wakim
- Lebanese University – Faculty of Medical Sciences –Department of Internal Medicine – Hadath – Lebanon
| | - Steven Safi
- Lebanese University – Faculty of Medical Sciences –Department of Internal Medicine – Hadath – Lebanon
| | - Elise Assouad
- Lebanese American University – School of Arts and Science – Department of Medicine – Byblos – Lebanon
| | - Pascale Salameh
- Lebanese University – Faculty of Medical Sciences –Department of Internal Medicine – Hadath – Lebanon
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Domek M, Li YG, Gumprecht J, Asaad N, Rashed W, Alsheikh-Ali A, Nabrdalik K, Gumprecht J, Zubaid M, Lip GY. One-year all-cause mortality risk among atrial fibrillation patients in Middle East with and without diabetes: The Gulf SAFE registry. Int J Cardiol 2020; 302:47-52. [DOI: 10.1016/j.ijcard.2019.12.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/08/2019] [Accepted: 12/29/2019] [Indexed: 12/17/2022]
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17
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Li YG, Miyazawa K, Wolff A, Zubaid M, Alsheikh-Ali AA, Sulaiman K, Lip GYH. One-year risks of stroke and mortality in patients with atrial fibrillation from different clinical settings: The Gulf SAFE registry and Darlington AF registry. Int J Cardiol 2018; 274:158-162. [PMID: 30291008 DOI: 10.1016/j.ijcard.2018.08.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/15/2018] [Accepted: 08/29/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Differences exist in oral anticoagulation (OAC) use between different populations with atrial fibrillation (AF), which may be associated with varying outcomes. PURPOSE We aimed to provide patient level comparisons of two cohorts of patients with AF, from the United Kingdom (UK) and Middle East (ME). METHODS The clinical characteristics, prescription of OAC, one-year risk of stroke and mortality were compared between individual patients with AF included into the Darlington AF registry (UK, n = 2258) and the Gulf SAFE (Survey of atrial fibrillation events) registry (ME, n = 1740). RESULTS A high percentage of patients from the Darlington registry were candidates for OAC (i.e., CHA2DS2-VASc score ≥2 in males or ≥3 in females; 82.0% in Darlington and 57.1% in Gulf SAFE). OAC use was suboptimal (52.0% in Darlington vs 58.4% in Gulf SAFE). One-year rates of stroke and mortality were high in both populations, especially in those with CHA2DS2-VASc score ≥2 in males and ≥3 in females (Darlington vs. Gulf SAFE: 3.51% vs. 5.63 for stroke; 11.4% vs. 16.8% for mortality). On multivariate analyses, female sex and previous stroke were independently associated with stroke events; while elderly age, female sex, vascular disease and heart failure were independent risk factors for mortality (all p < 0.05). Patients from Gulf SAFE registry had higher risk of stroke (odds ratio, 2.18 [1.47-3.23]) and mortality (odds ratio, 1.67 [1.31-2.14]) compared with those from Darlington registry. The CHA2DS2-VASc score showed good discrimination in predicting one-year risk of stroke (area under curve, 0.71 [0.65-0.76] in non-anticoagulated patients) and mortality (area under curve, 0.70 [0.68-0.72]) in the whole study population, as well as in Darlington or Gulf SAFE registry separately. CONCLUSIONS Stroke prevention was generally suboptimal in patient cohorts from the two registries, which was associated with high one-year risks of stroke and mortality, particularly so among patients from the Gulf SAFE registry. The higher risks for stroke and mortality in AF patients from the Gulf SAFE registry (compared to a UK cohort) merit further implementation of cardiovascular prevention strategies.
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Affiliation(s)
- Yan-Guang Li
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Chinese PLA Medical School, Beijing, China
| | - Kazuo Miyazawa
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andreas Wolff
- Division of Family Practice, Chilliwack General Hospital, Chilliwack, British Columbia, Canada
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
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