scholarly journals Women with atrial fibrillation in the Middle East: utilization of oral anticoagulant agents in a population with bad baseline clinical profiles and risk scores

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Hammoudeh ◽  
R Ibdah ◽  
S Rawashdeh ◽  
A Ababneh ◽  
A Al-Kasasbeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Middle East ◽  
Risk Score ◽  
Oral Anticoagulant ◽  
Middle Eastern ◽  
Risk Scores ◽  
Funding Sources ◽  
Middle Eastern Women ◽  
Anticoagulant Agents ◽  
Artery Disease

Abstract Background Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide and in the Middle East. Several studies have shown that women with AF are undertreated despite worse baseline clinical and risk profiles compared with men. It is largely unknown if this also applies to Middle Eastern AF patients. Purpose To evaluate baseline clinical features and utilization of guideline-recommended oral anticoagulant medications (OACs) in Middle Eastern women with AF. Methods The Jordan AF prospective multicenter study enrolled 2160 patients with AF, including 1164 (53.9%) women, in 20 hospital and outpatient clinics (May 2019 through January 2021). Results Nonvalvular AF was present in 1038 (91.0%) of women and 935 (94.6%) of men. Compared with men, women were older (mean age 69.2±11.5 years vs. 66.1±14.9 years, p<0.001), and had higher prevalence of hypertension (79.1% vs. 69.5%, p<0.001), diabetes (46.1% vs. 41.7%, p=0.04) and obesity (60.5% vs. 34.6%, p<0.001). Women, however, had lower prevalence of two comorbidities; heart failure (21.5% vs. 28.6, p=0.001) and coronary artery disease (7.7% vs. 15.4%, p<0.001) compared with men. Rate of utilization of oral anticoagulant agents (OACs) was higher in women than men with high and intermediate CHA2DS2 VASc scores (Table). Direct OACs were used in 64.0% of women and 63.3% of men with high risk score (p=NS). Multivariate analysis did not show sex to be an independent predictor of use of OACs. Conclusions Middle Eastern women with AF have worse baseline clinical and risk score profiles compared with men. In disagreement with other regional studies, the majority of these women received guideline-recommended OACs. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Adherence to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline on the Use of Oral Anticoagulant Agents in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ayman J. Hammoudeh ◽  
Yousef Khader ◽  
Nazih Kadri ◽  
Eyas Al-Mousa ◽  
Yahya Badaineh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Middle Eastern ◽  
Outpatient Clinics ◽  
Current Status ◽  
Anticoagulant Agents ◽  
Systemic Embolization ◽  
Clinical Profiles

Background. There is a scarcity of studies that evaluate adherence to the utilization of guideline-recommended oral anticoagulant agents (OACs) in patients with atrial fibrillation (AF) in the Middle East. The Jordan Atrial Fibrillation (JoFib) Study evaluated baseline clinical profiles and the utilization of OACs, including vitamin K antagonists (VKAs) and direct OACs (DOACs), in patients with valvular AF (VAF) and nonvalvular AF (NVAF) according to the 2019 focused update of the 2014 AHA/ACC/HRS guidelines. Methods. Consecutive patients with AF were enrolled in 29 hospitals and outpatient clinics. The use of OACs was evaluated in patients with VAF and NVAF according to the prespecified guideline. Results. Of 2000 patients, 177 (8.9%) had VAF and 1823 (91.1%) had NVAF. A VKA was prescribed for 88.1% of the VAF group. In the NVAF group, 1468 (80.5%) of patients had a high CHA2DS2-VASc score, i.e., a score of ≥3 in women and ≥2 in men; 202 (11.1%) patients had an intermediate CHA2DS2-VASc score, i.e., a score of 2 in women and 1 in men; and 153 (8.4%) patients had a low CHA2DS2-VASc score, i.e., a score of 1 in women and 0 in men. Of patients with a high CHA2DS2-VASc score, 1204 (82.0%) received OACs, including DOACs for 784 (53.4%) and VKA for 420 (28.6%) patients. Among patients with an intermediate score, OACs were prescribed for 148 (73.3%) patients, including 107 (53.0%) who received DOACs and 41 (20.3%) patients who received VKA. In patients with a low score, OACs were omitted in 94 (61.4%) patients and prescribed for 59 (38.6%) patients. Multivariate analysis showed that age between 50 and 70 years, CHA2DS2-VASc score of ≥2, a diagnosis of stroke or systemic embolization, and nonparoxysmal AF were significantly associated with increased odds of OAC prescription. Conclusions. The current status of the utilization of OACs in Middle Eastern AF patients appears to be promising and is consistent with the 2019 focused update of the 2014 AHA/ACC/HRS guideline. This trial is registered with NCT03917992.

scholarly journals A Transnational Dialogue from the Arab-Argentine Immigrant Press

1970 ◽  
pp. 5-9
Author(s):  
María del Mar Logroño Narbona
Keyword(s):  
Middle East ◽  
Middle Eastern ◽  
Middle Eastern Women ◽  
French Mandate

Beyond the geographical borders of the Middle East, discourses and debates about Middle Eastern women played an important role in the Arabic immigrant press inthe Mahjar (diaspora). This article explores the particular case of al-Istiklaal in the final moments and aftermath of the Great Syrian Revolt, “the largest, longest, andmost destructive of the Arab Middle Eastern revolts” (Provence, 2005, p. 12). From its first issue in June 1926 until late 1929, this Arab-Argentine newspaper systematically attacked the French Mandate and advocated for an independent Syria and Lebanon, which should be part of a larger pan-Arab political entity.

Abstract 18538: The ATRIA Stroke Risk Score Predicts Ischemic Stroke Better than CHADS2 and CHA2DS2-VASc in a large Swedish Cohort of Patients with Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sara Aspberg ◽  
Yuchiao Chang ◽  
Daniel Singer
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Risk Score ◽  
Stroke Risk ◽  
Anticoagulation Therapy ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Cut Points ◽  
Net Clinical Benefit ◽  
Better Than

Introduction: Atrial fibrillation (AF) is a major risk factor for acute ischemic stroke (AIS). Anticoagulation therapy (OAC) effectively prevents AIS, but increases bleeding risk. There is a need for better AIS risk prediction to optimize the anticoagulation decision in AF. The ATRIA stroke risk score (ATRIA) (table) was superior to CHADS2 and CHA2DS2-VASc in two large California community AF cohorts. We now report the performance of the 3 scores in a very large Swedish AF cohort. Methods: The cohort consisted of all Swedish patients hospitalized with a diagnosis of AF from July 1, 2005 to December 31, 2008. Predictor variables and the outcome, AIS, were obtained from inpatient ICD-10 codes. Warfarin use was determined from National Pharmacy Database. Risk scores were assessed via c-index (C) and net reclassification index (NRI). Results: The cohort included 158,370 AF patients off warfarin who contributed 340,332 person-years of follow-up, and 11,823 incident AIS, for an overall AIS rate of 3.47%/yr, higher than the 2%/yr seen in the California cohorts. Using the entire point score, ATRIA had a good C of 0.712 (0.708-0.716), significantly better than CHADS2, 0.694 (0.689-0.698), or CHA2DS2-VASc, 0.697 (0.693-0.702). Using published cut-points for Low/Moderate/High AIS risk, C deteriorated for all scores but ATRIA and CHADS2 were superior to CHA2DS2-VASc. NRI favored ATRIA; 0.16 (0.15-0.18) versus CHADS2; 0.22 (0.21-0.24) versus CHA2DS2-VASc. However, NRI decreased to near-zero when cut-points were altered to better fit the cohort’s stroke rates. Conclusion: Findings in this large Swedish AF cohort validate those in the California AF cohorts, with the ATRIA score predicting stroke risk better than CHADS2 or CHA2DS2-VASc. However, relative performance of the categorical scores varied by population stroke risk. Knowledge about this population risk may be needed to optimize cut-points on the multipoint scores to achieve better net clinical benefit from OAC.

scholarly journals Metabolic comparison of polycystic ovarian syndrome and control women in Middle Eastern and UK Caucasian populations

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Alexandra E. Butler ◽  
Ahmed Abouseif ◽  
Soha R. Dargham ◽  
Thozhukat Sathyapalan ◽  
Stephen L. Atkin
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Middle East ◽  
Diastolic Blood Pressure ◽  
Polycystic Ovary ◽  
Middle Eastern ◽  
Cross Sectional ◽  
Middle Eastern Women ◽  
Blood Pressures

Abstract To determine if metabolic characteristics differed in women with and without polycystic ovary syndrome (PCOS) between a Caucasian and Middle East population. Comparative cross-sectional analysis. Demographic and metabolic data from Middle Eastern women from Qatar Biobank (97 with PCOS, 622 controls) were compared to a Caucasian PCOS biobank in Hull UK (108 with PCOS, 69 controls). In both populations, PCOS women showed a worse cardiovascular risk profile of increased systolic and diastolic blood pressure, increased C-reactive protein (CRP), reduced HDL, insulin resistance as well as increased androgens compared to their respective controls without PCOS. UK women without PCOS had higher systolic and diastolic blood pressures, and increased testosterone results (p < 0.01) compared to Middle Eastern women without PCOS who had higher inflammatory markers (WBC and CRP), HDL and insulin resistance (p < 0.001). UK PCOS women had a higher body mass index, systolic and diastolic blood pressures, triglycerides (p < 0.01), whilst Middle Eastern PCOS women showed increased testosterone, free androgen index, HDL and CRP (P < 0.01). There was no difference in insulin or insulin resistance between the two PCOS cohorts. This study highlights ethnic population differences because, whilst cardiovascular risk indices were increased for both PCOS cohorts, this may be for different reasons: BMI, waist and hip measurements, systolic and diastolic blood pressure, and triglycerides were higher in the UK cohort whilst testosterone, HDL and CRP were higher in the Middle East population. Insulin resistance did not differ between the two PCOS populations despite differences in BMI.

P6559Long-term follow-up and outcomes of patients with discontinuation of oral anticoagulant therapy after successful ablation procedures for atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Fujino ◽  
H Yuzawa ◽  
T Kinoshita ◽  
M Shinohara ◽  
H Koike ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Low Risk ◽  
Risk Scores ◽  
Af Ablation ◽  
Successful Ablation

Abstract Background Oral anticoagulant therapy (OAT) is effective for preventing strokes in atrial fibrillation (AF) patients. Currently, there is controversy regarding the discontinuation of OATs in patients with ablation procedures to eliminate AF. Aim We investigated the incidence of major bleeding and ischemic strokes/systemic embolisms in low-risk patients that discontinued OATs after successful AF ablation procedures. Methods Of 330 consecutive patients that underwent AF ablation procedures and were prescribed one of the direct oral anticoagulants or warfarin, 207 AF patients (158 men, mean age 61±11 years) who discontinued OATs three months after the procedure were enrolled. The average CHADS2 and HAS-BLED scores were 1.0±0.9 and 1.2±1.0, respectively, which meant that most patients had a low risk for strokes. Results During follow-up, 31 patients (15%) had recurrences of AF. Those patients underwent a re-ablation procedure and then re-discontinued their OATs three months after the session. During a 60±13 months follow-up, major bleeding was observed in five patients (2.4%) and was associated with a higher HAS-BLED score (2.2±0.4 vs. 1.1±1.0, P=0.027). In contrast, none of the patients experienced ischemic strokes/systemic embolisms. Conclusions This prospective study demonstrated that in patients with successful ablation procedures and low risk scores for AF management, OATs could be discontinued three months after the procedure. Unnecessary continuation of OATs may increase the incidence of major bleeding during the follow-up.

scholarly journals 437 A score based on echocardiographic parameters highly predicts atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Hagemus ◽  
J T Sieweke ◽  
S Biber ◽  
S Schallhorn ◽  
J Neuser ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Score ◽  
Left Atrial ◽  
High Specificity ◽  
Volume Index ◽  
Risk Scores ◽  
Exclusion Criteria ◽  
The Past ◽  
Specificity And Sensitivity ◽  
Echocardiographic Parameters

Abstract Background Several scores indicating patients at high risk for atrial fibrillation (AF) have been developed. Early detection of AF supported by AF risk score is important to prevent embolic events such as ischemic stroke in these patients. However, specifity and sensitivity of AF risk scores available have to be improved. Echocardiographic parameters may significantly improve the diagnostic value of AF risk scores. Purpose To investigate whether a new AF risk score (LaHAsPa) including echocardiographic parameter of LA function and remodeling identifies patients with AF and is not inferior to other published AF risk scores (CHADS2-, ATLAS-, ARIC, simple CHARGE-AF-Score). Methods This monocentric, prospective, semi-blinded, controlled study screened 319 patients between 10/2017 and 04/2018 for eligibility. 290 patients were included after applying in- and exclusion criteria (Exclusion criteria: cardiac surgery in the past, highly graded valvular heart disease, pulmonary vein isolation or ablation of any other form of atrial arrhythmias in the past, myocardial ischemia in the recent past, class Ia antiarrhythmic therapy and AF during echocardiography). Standard parameters of heart function were determined by routine transthoracic echocardiography (TTE) as well as parameters indicating left atrial remodeling (Septal/lateral total atrial conduction time (s/l PA-TDI), left atrial volume index (LAVI)/a`). Two different investigators, blinded to each other and to AF status, determined the LaHAsPA-, CHADS2-, ATLAS-, ARIC, simple CHARGE-AF Score. Results Out of 290 patients (age 59.5 [45-71] yrs, female 121 (41.7%)) 66 patients had AF in the medical history. sPA-TDI and LAVI/a` are significantly altered in patients with AF compared to patients without of AF (sPA-TDI: 145 [117-158] vs. 111 [98-124], p &lt; 0.001; LAVI/a`: 4.5 [3.7-6.9] vs. 3.1 [2.4-4.1]). Multivariate Cox regression proportionality analysis highlighted sPA-TDI, and LAVI/a` as markers for prediction of AF (sPA-TDI: HR 1.11, 95%CI 1.00-1.23, p &lt; 0.04; LAVI/a`: HR 1.911, 95%CI 1.2-3.04). The LaHAsPA-Score, including hypertension, age, sPA-TDI and LAVI/a’, identified patients with AF with high specificity and sensitivity (area under the curve 0.993, 95%CI 0.99-1.0). Subsequently cut-off values determined for CHADS2-, ATLAS-, ARIC and simple CHARGE-AF Score, McNemar test for dichotomous distribution on dependent collectives highlighted the powerful predictive value of the LaHAsPA-risk Score. Conclusion(s) We demonstrate, that septal PA-TDI and LAVI/a` are highly predictive for AF presence. Our new AF score LaHAsPA consisting of variables easily to be determined in daily routine stratifies AF risk with high specificity and sensitivity. It might facilitate risk-dependent decision-making and potentially identifies patients with AF more precisely compared to commonly used AF scores. Additional prospective studies at greater scale are warranted to test this intriguing hypothesis.

Germline mutations in early-onset or hereditary breast cancer from the Middle East.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 20-20 ◽  
Author(s):  
Makia J Marafie ◽  
Rabea Al-Temaimi ◽  
Andre Megarbane ◽  
Fahd Al-Mulla
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Middle East ◽  
Middle Eastern ◽  
Germline Mutations ◽  
Illumina Platform ◽  
Family History Of Cancer ◽  
Middle Eastern Women ◽  
History Of ◽  
History Of Cancer

20 Background: Breast cancer is the most common cancer affecting women of Middle Eastern origin. Epidemiologically, breast cancer in the Middle East clusters in families and usually affects women a decade younger than Western women. This dilemma is compounded by the lack of curated databases and ambitious studies that address the roles genetic or genomic may play in breast cancer. Methods: We have exome sequenced 60 Middle Eastern women with moderate and strong family history of cancer or young women without significant family history of cancer. DNA extracted from peripheral blood of patients and matching normal Middle Eastern women without history of familial or sporadic cancers, were subjected to whole-exome sequencing using the HiSeq 2500 Illumina platform and MLPA to map major breast cancer–activating genetic defects. Results: Several novel BRCA1/2 mutations were identified in the minority of these women. However, other complex mutations in non-BRCA1/2 genes appear to play a more subtle role in breast cancer in the Middle Eastern women. Germline mutations in TP-53, BARD1 and mismatch repair genes were more frequent than expected by chance. Conclusions: BRCA1/2 gene mutations are not a significant cause of heritable cancers in the Middle East. The region may benefit from a well-curated region-specific database accessible to clinicians and scientists where clinical and variants information can be deposited from all over the Middle East.

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