One-year risks of stroke and mortality in patients with atrial fibrillation from different clinical settings: The Gulf SAFE registry and Darlington AF registry

Abstract

Background: AF patients from different clinical settings may have varying outcomes. We aimed to provide patient-level comparisons using two cohorts of patients with AF from different settings. Methods: The clinical characteristics, prescription of OAC, one-year risks of stroke and mortality were compared between patients with AF included into the Darlington AF registry (general practice-based cohort from the United Kingdom, n=2258) and the Gulf SAFE (Survey of atrial fibrillation events) registry (emergency room-based cohort from the Gulf countries, n=1740). Results: Patients from the Gulf SAFE registry were younger, had high prevalence of diabetes, vascular disease, heart failure. Patients from the Darlington registry had higher prevalence of hypertension, previous thromboembolism event, and higher mean stroke risk. OAC use was <60% in high stroke risk patients in both registries. On multivariate analyses, patients from Gulf SAFE were independently associated with higher risks of stroke (odds ratio, 2.18 [1.47-3.23]) and mortality (odds ratio, 1.67 [1.31-2.14]), especially in those with high CHA 2 DS 2-VASc score (≥2 in males, ≥3 in females) (Darlington vs. Gulf SAFE: 3.51% vs. 5.63 for stroke; 11.4% vs. 16.8% for mortality) Conclusions: Differences regarding AF patients profile, OAC use and outcomes exist in varying clinical settings as reflected by registries from different origins. Tailored AF management strategy are needed to fit in different clinical settings.

One-Year Clinical Outcome in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study

“…Our data confirm the considerable mortality and morbidity associated with AF, even in a contemporary clinical practice setting. The high one-year all-cause (11.4%) and cardiovascular (7.8%) mortality rates we reported are consistent with other studies from the Middle East, Asia, and other regions in the world, where all-cause mortality rates ranged between 5.2% and 15.3% and cardiovascular mortality rates ranged between 4.0% and to 7.0% [ 13 – 15 , 32 , 33 ]. The one-year risk of stroke/SE of 4.5% was not different from those reported by other studies [ 13 , 23 , 32 ].…”

“…The high one-year all-cause (11.4%) and cardiovascular (7.8%) mortality rates we reported are consistent with other studies from the Middle East, Asia, and other regions in the world, where all-cause mortality rates ranged between 5.2% and 15.3% and cardiovascular mortality rates ranged between 4.0% and to 7.0% [ 13 – 15 , 32 , 33 ]. The one-year risk of stroke/SE of 4.5% was not different from those reported by other studies [ 13 , 23 , 32 ]. The lower one-year rates of stroke/SE (<2%) reported by few investigators in the region were demonstrated in populations with lower CHA2DS2-VASc score [ 15 ] and by studies that involved single DOAC agent [ 14 , 34 ].…”

“…The lower one-year rates of stroke/SE (<2%) reported by few investigators in the region were demonstrated in populations with lower CHA2DS2-VASc score [ 15 ] and by studies that involved single DOAC agent [ 14 , 34 ]. The independent risk factors for all-cause mortality and for stroke/SE reported in patients with NVAF in this study were similar to other studies, namely, high-risk CHA2DS2-VASc score and past history of stroke which were the strongest two predictors of stroke/SE [ 32 , 35 ].…”

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

“…Contrary to the belief of valvular heart disease, and rheumatic mitral stenosis in particular, being the main cause of AF in developing countries, this study concurs with other Middle Eastern studies showing that <10% of all patients with AF have VAF [21,23,29]. This could be a reflection of decreasing incidence and prevalence of rheumatic heart disease in our region and the increasing prevalence of cardiovascular risk factors and comorbidities that predispose to NVAF including the demographic transition to an inverted age pyramid with an increase in numbers of older population, hypertension, diabetes mellitus, coronary heart disease, obesity, and sedentary lifestyles [30][31][32]. The rising burden of NVAF, among other cardiovascular diseases in developing countries, reflects a rising prevalence of noncommunicable diseases and leads to an increase in total mortality, morbidity, and health budgets in the region [33,34].…”

Stroke prevention of atrial fibrillation: Improving geographic under-use of contemporary antithrombotic approaches remains a challenge

“…The Gulf SAFE registry enrolled 2043 consecutive patients with AF from Kuwait, Bahrain, Qatar, United Arab Emirates, Oman and Yemen which were younger (57 vs. 67 years) and had fewer comorbidities, as indicated by the lower CHA 2 DS 2 -VASc score. Still, stroke/transient ischemic attack rates (4.2%) and all-cause mortality (13%) were much higher in this registry (compared to less than 1%, or less than 2% respectively, in the GLORIA-AF sub study [14] presumably due to insufficient use of anticoagulation, because in the Gulf SAFE registry only 58% of patients received a VKA and of those only 50% underwent regular INR checks [15] . This highlights that use of NOACs instead of VKAs is associated with a better treatment of AF patients independent of ethnicity or geographic region.…”