Demographics and Risk Profile of Elderly Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study

Abstract

Background

Atrial fibrillation (AF) is the most common arrhythmia that is associated with high morbidity and mortality. The prevalence of AF increases with age and the elderly constitute a vulnerable cohort for higher stroke and bleeding complications.

Methods

A total of 2163 adult consecutive patients with AF in 19 hospitals and 11 outpatient clinics in Jordan were enrolled in the Jordan AF study from May 2019 to January 2021. The clinical characteristics, demographics, and risk profiles of the elderly patients (≥80 years old) were compared to the younger patients (<80 years old).

Results

Of 2163 patients, 379 (17.5%) constituted the elderly group. The elderly group had higher prevalence of hypertension (79.9% vs 73.5%, p=0.01), lower prevalence of smoking (5.0% vs 15.2%, p<0.001) and lower body mass index (28.1 ± 5.5 kg/m² vs 29.8 ± 6.2 kg/m², p<0.001) compared with younger patients. They also had more strokes or systemic emboli (25.6% vs 14.7%, p<0.001), heart failure (30.3% vs 22.9%, p=0.002), pulmonary hypertension (30.6% vs 24.8%, p=0.02), and chronic kidney disease (13.5% vs 8.3%, p=0.002). The elderly cohort had higher mean CHA2DS2-VASc (5.0 ± 1.5 vs 3.6 ± 1.8, p<0.001) and HAS-BLED scores (2.2 ± 1.1 vs 1.5 ± 1.1, p<0.001) compared to younger group. Among 370 elderly with non-valvular AF (NVAF), oral anticoagulant agents (OACs) were prescribed for 278 (84.2%) of eligible high-risk patients. Of the 1402 younger patients with NVAF, OACs were prescribed for 1133 (84.3%) of eligible patients. Direct oral anticoagulant agents (DOACs) were more frequently used in the elderly compared to the young (72.3% vs 62.3%, p<0.001).

Conclusion

Elderly Middle Eastern AF patients have worse baseline clinical profiles and higher risk scores compared to younger patients. The majority of the elderly were prescribed guideline directed OACs, with higher use of DOACs than the younger cohort.

Clinical Studies Registration

The study is registered on clinicaltrials.gov (unique identifier number NCT03917992).

Keywords:

• atrial fibrillation
• elderly patients
• middle eastern patients
• risk scores

Data Sharing Statement

The authors intend to share all pertinent individual deidentified participant data. Data can be shared for 3 years after publication and will be available by contacting the corresponding author directly.

Ethics Statement

The study was approved by the Institutional Review Board of the following participating centers: Amman Surgical Hospital, Arab Medical Center, Essra Hospital, Ibn Haitham Hospital, Islamic Hospital, Istishari Hospital, Jordan Hospital, Khalidi Medical Center, King Abdullah University Hospital, King Hussein Medical Center, Prince Hamza Hospital, Prince Hashem Hospital, Queen Alia Cardiac Center, Salt Medical Center and Specialist Hospital.

All patients signed written informed consent and treatment decisions were left to the discretion of the treating physician.

Acknowledgments

The authors would like to thank the participating physicians who enrolled patients for the study (in alphabetical order): Abdallah Al-Kasasbeh, Abdelrahman Obiedat, Abdullah Bani-Melhim, Abdul Nasser Almohamed, Ahmad Abdelsattar, Ahmad Abu Awwad, Ahmad Sbaih, Ahmad Tamari, Alaa Ababneh, Alanoud Hamada, Alia Khamis, Ali Abu-Romman, Ali Shakhatreh, Amer Asia, Amin Ibdah, Amr Adas, Assem Nammas, Aws Mukhtar, Ayad Al Qudsi, Basil Abdeen, Dalia Rawashdeh, Eid Abu- Eid, Eyadeh Madanat, Eyas Al Mousa, Fahd Al-Karmi, Farah Al-Sayyed, Farah Halaweh, Fatima Al Nadi, Hana Al- Raie, Haneen Shawer, Hani Juha, Hanin Saleh, Hanna Makhamreh, Hazem Abu Asbeh, Hesham Janabi, Hisham Amin, Ibrahim Abbadi, Ibrahim Jarrad, Islam Abu Sedo, Islam Obeidat, Ismail Hamam, Kais Bilbeisi, Lama Khader, Leen Sharqawi, Liza Shaban, Lubaba Qabbaa, Lubna Haikal, Lubaba Qabbaah, Laith Habahbeh, Marwan Nemri, Marwan Al Sultan, Mo’ath Alfawar’a, Mohammad Abdah, Mohammad Afeef, Mohammad Al-Jawabreh, Mohammad Ali Jarrah, Mohammad Hani, Mohammad Kraishan, Mohannad Ababneh, Mohamad Jarrah, Mohammad Jabary, Munir Zaqqa, Mustafa Jammal, Myassar Amr, Nazih Kaderi, Noor Al-Badaineh, Obada Mansour, Odai Khasawneh, Oday Abu Ajameyyeh, Omar Abu Slieh, Omar Obeidat, Omar Salaymeh, Omran Abukhalaf, Osama Oudeh, Qusai Abu Ajameyyeh, Raed Awaisheh, Rami Bataineh, Ramzi Tabbalat, Rashid Abdah, Sa’ad Al-Muhaisen, Saed Al Ghamri, Safa’ Amro, Said Meri, Saleh Ghamdi, Sukaina Rawashdeh, Sara Al-Thunibat, Sara Younis, Sharif Adwan, Sulafa Saffarini, Tamer Salhab, Tawfiq Barqawi, Yahya Badaineh, Yahya Ismail, Yousef Khader, Zaid Dabash, Zeina Abu-Orabi, Zainab Salahat, Zainah Matani, Zakaria Shkoukani, and Zakariya Al-Hasanat.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest for this work.