Prevalence, Epidemiological Characteristics, and Pharmacotherapy of Coronary Artery Disease among Patients with Atrial Fibrillation: Data from Jo-Fib Study

The Intersection of Atrial Fibrillation and Coronary Artery Disease in Middle Eastern Patients. Analysis from the Jordan Atrial Fibrillation Study

Background

There is a scarcity of clinical studies which evaluate the association of atrial fibrillation (AF) and coronary artery disease (CAD) in the Middle East. The aim of this study was to evaluate the impact of CAD on baseline clinical profiles and one-year outcomes in a Middle Eastern cohort with AF.

Methods

Consecutive AF patients evaluated in 29 hospitals and cardiology clinics were enrolled in the Jordan AF Study (May 2019-December 2020). Clinical and echocardiographic features, use of medications and one-year outcomes in patients with AF/CAD were compared to AF/no CAD patients.

Results

Of 2020 AF patients enrolled, 216 (10.7%) had CAD. Patients with AF/CAD were more likely to be men and had significantly higher prevalence of hypertension, diabetes, dyslipidemia, heart failure and chronic kidney disease compared to the AF/no CAD patients. They also had lower mean left ventricular ejection fraction and larger left atrial size. Mean CHA2DS2 VASc and HAS-BLED scores were higher in AF/CAD patients than those with AF/no CAD (4.3 ± 1.7 vs. 3.6 ± 1.8, p < 0.0001) and (2.0 ± 1.1 vs. 1.6 ± 1.1, p < 0.0001), respectively. Oral anticoagulant agents were used in similar rates in the two groups (83.8% vs. 82.9%, p = 0.81), but more patients with AF/CAD were prescribed additional antiplatelet agents compared to patients with AF/no CAD (73.7% vs. 41.5%, p < 0.0001). At one year, AF/CAD patients, compared to AF/no CAD patients had significantly higher hospitalization rate (39.4% vs. 29.2%, p = 0.003), more acute coronary syndrome and coronary revascularization (6.9% vs. 2.4%, p = 0.004), and higher all-cause mortality (18.5% vs. 10.9%, p = 0.002).

Conclusions

In this cohort of Middle Eastern patients with AF, one in 10 patients had CAD. The coexistence of AF and CAD was associated with a worse baseline clinical profile and one-year outcomes. Clinical study registration: the study is registered on clinicaltrials.gov (unique identifier number NCT03917992).

Bibliometric Insights Into the Evolution of Atrial Fibrillation and Dementia Research 2002-2022

BACKGROUND In response to the escalating prevalence of atrial fibrillation (AF) and its potential correlation with cognitive impairment and dementia, we conducted a comprehensive bibliometric analysis to assess current research trends, contributors, and collaborative networks in this evolving interdisciplinary field. MATERIAL AND METHODS Articles published between 2002 and 2022 were extracted from the Web of Science database and carefully screened, yielding 328 publications. Two reviewers independently conducted the screening and quality appraisal. We employed sophisticated tools such as CiteSpace, VOSviewer, and Bibliometrix (R-Studio's R tool) to succinctly summarize and thoroughly analyze the publications. RESULTS A total of 328 publications, comprising 262 papers and 66 reviews, were included in the final analysis. The number of publications exhibited a consistent year-on-year increase, demonstrating an average annual growth rate of 20.57%. These publications originated from 41 countries and regions, with the highest contributions observed from the United States, United Kingdom, Italy, and China. Notably, the University of Liverpool emerged as the most prolific institution, while the most prolific author was Lip GYH from the United Kingdom. The journal with the most publications is the journal of the American Heart Association (19 articles). The most popular keywords in order were: risk and stroke (n=101), dementia (n=100), decline (n=70), prevalence (n=67), and Alzheimer's disease. CONCLUSIONS This study shows the current research status and emerging trends in atrial fibrillation's link to dementia and cognitive impairment. It highlights global growth and collaboration patterns while offering a comprehensive view of their interrelationship, pointing toward future research directions.

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

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.