Gender differences in one-year unplanned readmissions in atrial fibrillation: Trends from a conflict-stricken country

IntroductionAtrial fibrillation (AF) is the most common arrhythmia worldwide, yet long-term outcomes in conflict-affected regions are poorly understood. Gender-based disparities in AF outcomes have been reported in high-income countries but remain unexplored in fragile healthcare systems.MethodsWe conducted a retrospective cohort study at Latakia's University Hospital in Latakia, Syria between June/2021-November/2023. Adult patients admitted with primary AF were followed for 1 year to assess unplanned readmissions. Data on unplanned readmissions were defined as non-elective hospitalisations occurring within 1 year after index discharge. These were unscheduled admissions, usually prompted by recurrence of symptoms, acute decompensation, or cardiovascular events. Data were collected from medical records.ResultsOf the included 657 patients (52% male, median age 60 years), 422 (64%) had at least one unplanned readmission within 1 year. Cardiac causes accounted for 67% of readmissions, with recurrent AF responsible for 75% of those. Females had higher all-cause (73% vs 56%) and cardiovascular (53% vs 34%) readmission rates than males (both p < 0.001). On multivariable analysis, independent predictors of readmission included female sex (HR 1.7, 95% CI 1.4-2.0), age ≥60 (HR 3.7, 95% CI 2.9-4.6), diabetes mellites (DM) (HR 1.5, 95% CI 1.2-1.8), and congestive heart failure (CCF) (HR 3.3, 95% CI 2.6-4.6). Females were more likely to have two (44%) or three or more (44%) readmissions than males.ConclusionsOne-year readmissions after AF admission were high, particularly among females. Female gender was an independent risk factor, highlighting the need for gender-sensitive follow-up strategies in resource-limited settings.