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Published on: February 26, 2013
The Intersection of Atrial Fibrillation and Coronary Artery Disease in Middle Eastern Patients. Analysis from the
Ayman Hammoudeh1, Yahya Badaineh1, Ramzi Tabbalat2
1Department of Cardiology, Istishari Hospital, 44 Kindi Street, Amman 11954, Jordan.
Insights
In Middle Eastern patients with atrial fibrillation (AF), coronary artery disease (CAD) affects 10.7% and is linked to poorer health and worse one-year outcomes. This highlights the importance of managing both conditions together.
Area of Science:
- Cardiology
- Internal Medicine
- Epidemiology
Background:
- Limited clinical research exists on the association between atrial fibrillation (AF) and coronary artery disease (CAD) in the Middle East.
- Understanding this comorbidity is crucial for managing cardiovascular health in the region.
Purpose of the Study:
- To assess the impact of CAD on the clinical characteristics of Middle Eastern patients with AF.
- To evaluate the one-year outcomes for AF patients with and without concomitant CAD.
Main Methods:
- The Jordan AF Study enrolled 2020 AF patients from May 2019 to December 2020 across 29 centers.
- Compared clinical profiles, medication use, and one-year outcomes between AF patients with CAD (AF/CAD) and those without (AF/no CAD).
Main Results:
- 10.7% of AF patients had CAD. AF/CAD patients exhibited higher rates of hypertension, diabetes, heart failure, and chronic kidney disease.
- AF/CAD patients had higher CHA₂DS₂-VASc and HAS-BLED scores, lower ejection fraction, and larger left atrial size.
- One-year outcomes showed higher hospitalization rates, acute coronary syndrome, revascularization, and all-cause mortality in the AF/CAD group.
Conclusions:
- The coexistence of AF and CAD in Middle Eastern patients is associated with a more complex clinical profile.
- Patients with both AF and CAD experienced significantly worse one-year outcomes, including increased mortality.
- This study underscores the need for integrated management strategies for AF and CAD in this population.
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).
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