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

Ayman J Hammoudeh; Yousef Khader; Nazih Kadri; Eyas Al-Mousa; Yahya Badaineh; Laith Habahbeh; Ramzi Tabbalat; Hesham Janabi; Imad A Alhaddad

doi:10.1155/2021/5515089

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

Int J Vasc Med. 2021 Apr 8:2021:5515089. doi: 10.1155/2021/5515089. eCollection 2021.

Authors

Ayman J Hammoudeh¹, Yousef Khader², Nazih Kadri³, Eyas Al-Mousa¹, Yahya Badaineh¹, Laith Habahbeh¹, Ramzi Tabbalat³, Hesham Janabi⁴, Imad A Alhaddad^{5

6}

Affiliations

¹ Cardiology Department, Istishari Hospital, 44 Kindi Street Amman 11184, Jordan.
² Department of Public Health, Jordan University of Science and Technology School of Medicine, 3030 Ramtha Street, P.O. Box 3030, Irbid 22110, Jordan.
³ Electrophysiology and General Cardiology Sections, Cardiology Department, Abdali Hospital, 1 Al-Istethmar Street, Abdali Boulevard, Amman 11190, Jordan.
⁴ Intensive Care Unit, Istishari Hospital, 44 Kindi Street, Amman 11184, Jordan.
⁵ Cardiology Department, Aqaba Isl Hospital, 15 Sharif Shaker Ben Zaidstreet, Aqaba 77110, Jordan.
⁶ Cardiology Department, Jordan Hospital, 9 Nuzha Street, Amman 11196, Jordan.

Abstract

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.

Associated data

ClinicalTrials.gov/NCT03917992