Characteristics and outcomes of Middle Eastern patients with atrial fibrillation and history of prior stroke or systemic embolism.

Abstract

Objective: To describe the sociodemographic and clinical characteristics of Middle Eastern patients with atrial fibrillation (AF) and a history of prior ischemic stroke/systemic embolism (SSE) and compare the risk of adverse events between AF patients with and without prior SSE from the Middle East.

Methods: The study population was recruited from the JoFib study, a multicenter, nationwide, prospective registry of patients with AF from the Middle East. Patients were categorized into two study groups according to the history of prior SSE.

Results: The current study population consisted of 2003 AF patients divided into two groups: a prior SSE group of 318 (15.9%) patients and a no prior SSE group of 1685 (84.1%). Patients with prior SSE were older than those without prior SSE (45.3% vs. 30.4%, < 0.001). Compared to the no prior SSE group, patients with prior SSE were less symptomatic (61.3% vs. 72.8%, p < 0.001), had a higher prevalence of diabetes (49.1% vs. 42.4%, p = 0.03) and dyslipidemia (51.9% vs. 43.6%, p = 0.007), and were less commonly obese (34.0% vs. 42.2%, p = 0.009). Rhythm-control strategies were less frequently pursued in patients with prior SSE compared to the no prior SSE group (16.0% vs. 22.0%, p = 0.02). Antithrombotic medications were used more frequently by the prior SSE group, including anticoagulants (89.0% vs. 80.7%, p < 0.001) and antiplatelets (48.4% vs. 37.6%, p < 0.001). Compared to the no prior SSE group, the prior SSE group was at greater risk of all-cause death (aHR 1.64, 95% CI 1.21-2.22), cardiovascular death (adjusted sub-hazard ratio [aSHR], 95% CI: 1.50, 1.04-2.16), non-cardiovascular death (1.76, 1.00-3.08), and SSE (3.05, 1.83-5.07). History of prior SSE did not significantly alter the risk of major bleeding (0.67, 0.27-1.65) or CRNMB (AOR 0.79, 95% CI 0.47-1.33).

Conclusion: A F patients with prior SSE are at higher risk of adverse events compared to patients without prior SSE.