Effect of conflict on atrial fibrillation outcomes in the Middle East: Multicenter international cohort study

Atrial fibrillation (AF) outcomes vary depending on the stability of the health care system.

This study compared AF outcomes in 2 neighboring Levant countries: Syria, a conflict-affected country, and Jordan, a country with a stable health care system.

We conducted a retrospective observational cohort study of patients with AF from Tishreen University Hospital in Latakia, Syria, and the Jordanian Atrial Fibrillation Registry. Propensity score matching was performed to adjust for baseline characteristics. Primary outcomes included 1-year readmission rates and the 1-month incidence of cerebrovascular accidents (CVAs) or major bleeding.

The study included 2677 patients (657 from Syria and 2020 from Jordan). Syrian patients were younger (median age 60 years vs 70 years; P < .001) and had higher rates of smoking (39% vs 14%; P < .001) and ischemic heart disease (26% vs 12%; P < .001) but lower rates of hypertension and diabetes. One-year readmission rates were significantly higher in Syria (64% vs 9%; P < .001), as were the incidences of 1-month CVAs (3% vs 1%; P < .001) and major bleeding (4% vs 0.5%; P < .001). These differences remained significant after propensity score matching. Compared with Jordanian patients, Syrian patients were associated with a substantial increase in all-cause readmission (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.5-2.6; P < .001). Furthermore, Syrian patients had a considerable increase in incidences of 1-month CVA (OR 6.5; 95% CI 2.5-16.5; P < .001) and major bleeding (OR 20.6; 95% CI 6.7-63.3; P < .001).

AF outcomes are significantly worse in Syria than in Jordan. Health care disruptions contribute to increased readmissions and complications. Strengthening AF management in conflict zones through improved access to medications and structured follow-up is essential to mitigating adverse outcomes.