Atrial fibrillation inpatient management patterns and clinical outcomes during the conflict in Syria: An observational cohort study

BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there is no data on AF inpatient management strategies and clinical outcomes in Syria.ObjectivesThe 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.MethodsA 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).ResultsThe 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.ConclusionSyrian 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.

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

Background

The EuroQoL 5 dimensions is the first validated questionnaire to assess quality of life (QoL) in patients with atrial fibrillation (AF) in Syria.

Objective

This study aimed to evaluate the gender disparity in QoL in Syrian patients with AF during the ongoing conflict.

Methods

The study involved patients admitted to the emergency department of Tishreen University Hospital in Latakia, Syria, with AF as the primary diagnosis between June 2023 and June 2024. Arabic versions of the EuroQoL 5 dimensions were administered to patients on admission, and their demographic data were taken from their medical notes.

Results

A total of 406 satisfied the study criteria, of whom 180 (44%) were males; and the median age was 67 (57- 73) years. Compared with men, women had more congestive cardiac failure (CCF) (32% vs 22%; P=.001) and were more uneducated (48% vs 27%; P<.001). Females demonstrated poorer QoL across all scoring dimensions (activities: 2.4 vs 1.7; mobility: 2.5 vs 1.6; self-care: 2.6 vs 1.8; pain: 2.6 vs 1.7; anxiety: 2.9 vs 1.8; EuroQol Visual Analogue Scale: 49.8 vs 79.8), all of which had P<.001. Multivariable logistic regression demonstrated that women (odds ratio [OR]: 5.2; 95% confidence interval [CI] 2.2-7.6; P<.001 and OR 6.2; 95% CI 3.1-9.7; P<.001) and CCF (OR 3.3; 95% CI 1.5-6.9; P<.001 and OR 4.2; 95% CI 2.2-7.3; P<.001) were independently associated with poor QoL.

Conclusion

Syrian women admitted with AF had poorer QoL than did their men counterparts. CCF and female sex were independent predictors of poor QoL.

Six-Month Emergent Readmissions Following Hospitalization for Atrial Fibrillation Amid the Syrian Conflict: A Real-World Observational Cohort Study

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia worldwide. However, data regarding readmissions following index admission for AF in the developing world are not well described. This study assessed the rate, predictors, and trends of 6-month readmission after index admission for AF in Syria.

METHODS

We included adult patients who had an index admission with AF to Latakia's tertiary center between July 2021 and November 2023. Patients were monitored for readmission for 6 months after index discharge. Data were taken from the patient's medical notes.

RESULTS

A total of 649 patients were included in the final analysis, of which 320 (49%) were readmitted to the hospital within 6 months following index admission. Cardiac causes were the most common cause of readmission in 76% of patients, of which 70% were AF. Readmitted patients had a higher median age (64 vs. 58; p = 0.001) and fewer males (49% vs. 36%; p = 0.001). In multivariate analysis, factors that independently increased 6-month readmission risk were age ≥ 60 years (hazard ratio [HR]: 1.7, 95% CI: 1.4-2.2), females (HR: 2.2, 95% CI: 1.6-2.7), and congestive heart failure (CCF) (HR: 2.1, 95% CI: 1.4-2.6). Most cardiac readmissions (76%) happened during the first 60 days following index discharge.

CONCLUSION

Almost half the patients were readmitted within 6 months after an index admission for AF. Females, CCF, and advancing age were independently associated with an increased risk of 6-month readmission.

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.

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.

Role of the CHA2DS2-VASc score in predicting hospital stay and 90-day readmission among patients with atrial fibrillation in Syria

OBJECTIVES

We assessed the CHA2DS2-VASc score for predicting hospital readmission risk and length of stay (LOS) in patients admitted with primary atrial fibrillation (AF).

METHODS

This retrospective cohort study included patients with index admission for AF to Latakia's tertiary center (May 2021-November 2023). Patients were followed 90 days to assess readmission. CHA2DS2-VASc was correlated with 90-day readmission, inpatient all-cause mortality, and LOS during index admission.

RESULTS

In total, 717 patients were included; 320 (45%) were readmitted to the hospital within 90 days (58% men, 65% aged <65 years). Inpatient mortality was 4%; the median LOS was 2 days. There was an increase in the incident rate ratio (IRR) of LOS starting from a CHA2DS2-VASc of 2 (IRR: 2, 95% confidence interval [CI]: 1.7-2.2) to a score of >6 (IRR: 5, 95% CI: 1.8-10.7), compared with a score of 0. There was an incremental increase in the hazard ratio (HR) of readmission from a score of 1 (HR: 2.3, 95% CI: 1.3-4.1) to a score of >6 (HR: 41, 95% CI: 31-72) compared with a CHA2DS2-VASc of 0.

CONCLUSION

CHA2DS2-VASc could predict 90-day hospital readmission and LOS during the index admission in patients admitted with primary AF.

Thirty-day unplanned readmissions following hospitalization for atrial fibrillation in a tertiary Syrian center: A real-world observational cohort study

Background

Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding 30-day readmission following index admission for AF in the developing world are poorly described.

Objectives

The study aimed to assess the rate, predictors, and trends of 30-day readmission after index admission for AF in Syria.

Methods

We included adult patients who had an index admission with AF to Latakia's tertiary center between June 2021 and October 2023. Patients were monitored for readmission for 30 days after index discharge. Data were taken from patients' medical notes.

Results

A total of 661 patients were included in the final analysis, of which 282 (43%) were readmitted to hospital within 30 days following index admission. Cardiac causes were the most common cause of readmission in 72% of patients, of which 60% were AF. Readmitted patients had a higher median age (62 years vs 57 years, P = .001), and there were fewer males (58% vs 51%, P = .001). In multivariate analysis, factors that independently increased 30-day readmission risk were older age (hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.1-1.9), female sex (HR 1.3, 95% CI 1.02-1.4), diabetes mellitus (HR 1.7, 95% CI 1.3-2.3), and congestive heart failure (HR 2.2, 95% CI 1.7-2.9). Most cardiac readmissions happened during the first 15 days (79%).

Conclusion

Almost 1 in 2 patients were readmitted within 30 days after an index admission for AF. Female sex, advancing age, diabetes mellitus, and congestive heart failure were independently associated with an increased risk of 30-day readmission.

The validity and reliability of the Arabic version of the EQ-5D in atrial fibrillation patients in a conflict country: a study from Syria

BACKGROUND

The EQ-5D is one of the most commonly used tools to establish health-related quality of life (QoL). EQ-5D data in atrial fibrillation (AF) patients in the Middle East are lacking.

OBJECTIVES

This study aims to evaluate the reliability and validity of the Arabic version of the EQ-5D in AF inpatients in Syria.

METHODS

The study involved patients admitted to the emergency department of Tishreen's University Hospital in Latakia with AF as the primary diagnosis between the 1st of June 2021 and the 1st of June 2023. Arabic versions of the EQ-5D, EQ-VAS and SF36 questionnaires were administered to patients. Validation was done using convergent, discriminant, and known-groups validity, while reliability was conducted using EQ-5D retesting within 2-4 weeks.

RESULTS

432 participants were included in the study with a mean ± standard deviation of 63 ± 15. Males represented 242 (56%) of the participants. All hypotheses relating EQ-5D responses to external variables were satisfied. All three validation hypotheses demonstrated that the EQ-5D had the convergent, discriminant and known group validity to assess QoL in this cohort. The intraclass correlation coefficient (ICC) for test-retest reliability ranged between 0.74 and 0.88, while Cohen's κ ranged between 0.72 and 0.86. Cronbach's α value for internal consistency was 0.73.

CONCLUSION

The Arabic version of EQ-5D was valid and reliable in measuring QoL in AF inpatients in Syria. This validation opens the door for more widespread use of the EQ-5D in Arabic-speaking regions, facilitating better-informed healthcare decisions and improving patient care strategies in Syria and other Middle Eastern countries.

Incidence, outcomes, and predictors of new heart failure in syrian conflict-affected population following hospitalization for atrial fibrillation: A retrospective cohort study

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding readmission for new congestive heart failure (CHF) following index admission for AF in the developing world are poorly described.

OBJECTIVES

The study aimed to assess the rate, predictors, and outcomes of 120-day CHF readmission after index admission for AF in Syria.

METHODS

This retrospective cohort study collected all adult patients without known CHF who had an index admission with AF to Latakia's tertiary center between June 2021-December 2023. Data were taken from patients' medical notes. The primary outcome included readmission with incident CHF within 120 of index discharge, and secondary outcomes included predictors and outcomes of these CHF readmissions.

RESULTS

A total of 660 patients were included in the final analysis, of which 69 (11.7%) were readmitted with new CHF within 120 days of index discharge. Readmitted patients had higher median age (58 vs 70 years, p < .001). Factors that independently increased 120-day CHF incidence were age ≥60 years (HR: 9.8, 95% CI: 4.8-23.6, p < .001), diabetes mellitus (DM) (HR:2.9, 95% CI:1.7-4.9, p < .001), valvular heart disease (VHD) (HR:1.7, 95% CI:1.04-2.78, p = .047), and hypertension (HR:2.5, 95% CI:1.5-4, p < .001). Inpatient mortality occurred in six readmitted patients (9%). LVEF <40% (HR:6.7, 95% CI: 24.31, p = .01) and DM (HR:7.2, 95% CI: 1.9-33, p = .004) were independently associated with inpatient mortality.

CONCLUSION

Hospitalization for new CHF was common in Syrian patients discharged with AF. The clinical predictors of incident CHF emphasize the importance of integrated management of lifestyle risk factors and common comorbidities in AF patients to optimize outcomes in resource-depleted communities.

Contribution of Arab world in transplant research: A PubMed-based bibliometric analysis

BACKGROUND

The Arab world consists of 22 countries situated in the Middle East and North Africa, tied together by linguistic and cultural bonds. Over numerous past decades, this region tended to fall behind regarding biomedical research. Organ, tissue, and cell transplantation are life-saving and life-improving treatments for various diseases. Given the positive correlation between research activity and the improvement of the clinical frame of transplantation, this article intended to examine the regional activity of transplantation research between 2005 and 2019.

METHODS

Using the PubMed database, the number of transplantation-related articles published by each country, and regarding 26 different procedures, was assessed. The results were normalized with respect to each country's average population & average Gross Domestic Product (GDP). In addition, the co-occurrence of keywords and the co-authorships were analyzed by VOS Viewer.

RESULTS

Arab countries contributed to 1.25% of total transplantation publications. The number of transplantation publications had an inflection in 2013, with the last six years alone contributing to 65.27% of the overall regional transplantation-related publications. Kuwait and Lebanon ranked first in terms of publications per million persons, while Egypt ranked first in terms of publications per national GDP. Stem cell, bone & kidney transplantations had the highest number of Arab transplantation-related publications. Low levels of collaboration between authors and organizations were observed, besides a modest but increasing trend towards experimental work on animals and newer therapies.

CONCLUSION

Despite the increase in transplant-related research activity in recent years, the Arab world still lags behind in this field compared to the worldwide contribution.