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

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.