Kuwait Atrial Fibrillation Management Analysis-Insights From a Tertiary Center in Kuwait

Real-world data on atrial fibrillation (AF) contemporary management from the Gulf region are scarce and nonexistent from Kuwait. Despite recent guideline updates favoring early rhythm control, clinical characteristics, treatment strategies, and outcomes remain poorly characterized in this region. This study aimed to evaluate AF management patterns at a tertiary center in Kuwait, focusing on rhythm vs. rate control strategies and direct oral anticoagulant (DOAC) prescribing practices.

An observational study on adult patients diagnosed with AF at Al Dabbous Cardiac Center between 2013 to 2022 was conducted. Demographic data, relevant clinical characteristics, and investigations were extracted. The primary outcome was the prevalence and predictors of rhythm control. Secondary outcomes included all-cause and cardiovascular-related hospitalizations. The appropriateness of DOAC dose-reduction was assessed based on guideline-based criteria.

Of 558 records screened, 457 patients with non-valvular AF were included. Rhythm control was pursued in 28.9% of cases, most commonly via direct current cardioversion (47.3%). Patients selected for rhythm control were more likely to be younger (mean age 64 vs. 70 years, p < 0.001), male (61.1% vs. 38.9%, p = 0.024), and followed in electrophysiology clinics (33% vs. 5%, p < 0.001). Rhythm control strategy was independently associated with greater odds of cardiovascular-related hospitalizations (adjusted OR = 2.89, 95% CI: 1.12-7.48, p = 0.028). Among patients receiving reduced-dose DOACs (68.8%), 11.6% of patients were underdosed despite the absence of criteria for dose reduction.

Rhythm control was underutilized in our study population, falling short of international benchmarks and guideline recommendations. Disparities in rhythm control utilization based on sex and referral patterns were observed. Additionally, among patients on dose-reduced DOACs, a significant proportion of them were underdosed. These findings highlight the need to enhance awareness of evidence-based AF management and to promote adherence to guideline-directed therapy.