Mohammad Zubaid

In the Middle East, atrial fibrillation (AFib) affects a relatively young, high-risk population that suffers poor one-year outcomes, according to results of the Gulf SAFE study presented on Nov. 7 at AHA 2012.

The trial, which was based on 2,043 patients in Kuwait, the United Arabs Emirates, Oman, Yemen, Qatar and Bahrain, found that Middle Eastern patients with non-valvular AFib are relatively young in comparison to the rest of the world and have high incidence of metabolic risk factors. Mean age in the study population was 59.1 years, and only 39.9 percent of patients were older than 65 years. Nearly 60 percent had hypertension, 32.7 percent diabetes, 32.1 percent coronary artery disease and 26.8 percent heart failure. Other common comorbidities included smoking, left ventricular systolic dysfunction and chronic obstructive pulmonary disease.

In addition, study investigators found that anticoagulation management is suboptimal and that rhythm management in the emergency room resulted in low rates of cardioversion attempts and high rates of hospital admission. At one-year follow-up, the all-cause mortality rate was 15.3 percent, 14 percent of patients had visited an emergency department for AFib and 11.1 percent were admitted to hospital for AFib. The stroke/transient ischemic attack rate was 4.2 percent, the investigators said.

Given that most research on AFib outcomes is derived from data from North America or Europe, the Gulf SAFE study provides an opportunity to better understand the AFib population in the Middle East and from there identify management strategies that can reverse the poor outcomes observed, said Mohammad Zubaid, MB, ChB, FRCPC, FACC, professor of medicine, Kuwait University, who presented on behalf of the trial.