Six-Month Emergent Readmissions Following Hospitalization for Atrial Fibrillation Amid the Syrian Conflict: A Real-World Observational Cohort Study

Overview

Journal J Cardiovasc Electrophysiol

Date 2025 Jan 13

PMID 39803787

Authors

Ibrahim Antoun

Alkassem Alkhayer

Alamer Alkhayer

Khaled Yazji

Riyaz Somani

G Andre Ng

Mustafa Zakkar

Affiliations

Soon will be listed here.

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide. However, data regarding readmissions following index admission for AF in the developing world are not well described. This study assessed the rate, predictors, and trends of 6-month readmission after index admission for AF in Syria.

Methods: We included adult patients who had an index admission with AF to Latakia's tertiary center between July 2021 and November 2023. Patients were monitored for readmission for 6 months after index discharge. Data were taken from the patient's medical notes.

Results: A total of 649 patients were included in the final analysis, of which 320 (49%) were readmitted to the hospital within 6 months following index admission. Cardiac causes were the most common cause of readmission in 76% of patients, of which 70% were AF. Readmitted patients had a higher median age (64 vs. 58; p = 0.001) and fewer males (49% vs. 36%; p = 0.001). In multivariate analysis, factors that independently increased 6-month readmission risk were age ≥ 60 years (hazard ratio [HR]: 1.7, 95% CI: 1.4-2.2), females (HR: 2.2, 95% CI: 1.6-2.7), and congestive heart failure (CCF) (HR: 2.1, 95% CI: 1.4-2.6). Most cardiac readmissions (76%) happened during the first 60 days following index discharge.

Conclusion: Almost half the patients were readmitted within 6 months after an index admission for AF. Females, CCF, and advancing age were independently associated with an increased risk of 6-month readmission.

Citing Articles

Hypertension and Atrial Fibrillation: Bridging the Gap Between Mechanisms, Risk, and Therapy.

Antoun I, Layton G, Nizam A, Barker J, Abdelrazik A, Eldesouky M Medicina (Kaunas). 2025; 61(2).

PMID: 40005478 PMC: 11857777. DOI: 10.3390/medicina61020362.

References

Johnson B, Smoyer-Tomic K, Siu K, Walker D, Sander S, Huse D . Readmission among hospitalized patients with nonvalvular atrial fibrillation. Am J Health Syst Pharm. 2013; 70(5):414-22. DOI: 10.2146/ajhp120461. View

Lubitz S, Moser C, Sullivan L, Rienstra M, Fontes J, Villalon M . Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community. J Am Heart Assoc. 2013; 2(5):e000126. PMC: 3835216. DOI: 10.1161/JAHA.113.000126. View

Kakaje A, Alhalabi M, Alyousbashi A, Ghareeb A, Hamid L, Al-Tammemi A . Smoking habits and the influence of war on cigarette and shisha smoking in Syria. PLoS One. 2021; 16(9):e0256829. PMC: 8412248. DOI: 10.1371/journal.pone.0256829. View

Joseph P, Healey J, Raina P, Connolly S, Ibrahim Q, Gupta R . Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals. Cardiovasc Res. 2020; 117(6):1523-1531. DOI: 10.1093/cvr/cvaa241. View

Kherallah M, Alahfez T, Sahloul Z, Eddin K, Jamil G . Health care in Syria before and during the crisis. Avicenna J Med. 2013; 2(3):51-53. PMC: 3697421. DOI: 10.4103/2231-0770.102275. View

Jencks S, Williams M, Coleman E . Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 360(14):1418-28. DOI: 10.1056/NEJMsa0803563. View

Alhaffar M, Janos S . Public health consequences after ten years of the Syrian crisis: a literature review. Global Health. 2021; 17(1):111. PMC: 8449996. DOI: 10.1186/s12992-021-00762-9. View

Al-Shamkhani W, Ayetey H, Lip G . Atrial fibrillation in the Middle East: unmapped, underdiagnosed, undertreated. Expert Rev Cardiovasc Ther. 2018; 16(5):341-348. DOI: 10.1080/14779072.2018.1457953. View

Bumpus S, Krallman R, McMahon C, Gupta A, Montgomery D, Kline-Rogers E . Insights into hospital readmission patterns of atrial fibrillation patients. Eur J Cardiovasc Nurs. 2020; 19(6):545-550. DOI: 10.1177/1474515120911607. View

10.

Tripathi B, Atti V, Kumar V, Naraparaju V, Sharma P, Arora S . Outcomes and Resource Utilization Associated With Readmissions After Atrial Fibrillation Hospitalizations. J Am Heart Assoc. 2019; 8(19):e013026. PMC: 6806041. DOI: 10.1161/JAHA.119.013026. View

11.

Freeman J, Wang Y, Akar J, Desai N, Krumholz H . National Trends in Atrial Fibrillation Hospitalization, Readmission, and Mortality for Medicare Beneficiaries, 1999-2013. Circulation. 2017; 135(13):1227-1239. DOI: 10.1161/CIRCULATIONAHA.116.022388. View

12.

Antoun I, Alkhayer A, Aboud Y, Alkhayer H, Kotb A, Alkhayer A . COVID-19 inpatient treatments and outcomes during the conflict in Syria: an observational cohort study. IJID Reg. 2023; 7:72-76. PMC: 9797414. DOI: 10.1016/j.ijregi.2022.12.009. View

13.

Woods T, Ngo L, Speck P, Kaambwa B, Ranasinghe I . Thirty-Day Unplanned Readmissions Following Hospitalisation for Atrial Fibrillation in Australia and New Zealand. Heart Lung Circ. 2022; 31(7):944-953. DOI: 10.1016/j.hlc.2022.02.006. View

14.

Weber C, Hung J, Hickling S, Li I, Murray K, Briffa T . Emergent readmission and long-term mortality risk after incident atrial fibrillation hospitalisation. Heart. 2022; 109(5):380-387. DOI: 10.1136/heartjnl-2022-321560. View

15.

Antoun I, Alkhayer A, Aljabal M, Alkhayer A, Simon P, Mahfoud Y . The validity and reliability of the Arabic version of the EQ-5D in atrial fibrillation patients in a conflict country: a study from Syria. BMC Cardiovasc Disord. 2024; 24(1):541. PMC: 11460179. DOI: 10.1186/s12872-024-04203-4. View

16.

Antoun I, Aljabal M, Alkhayer A, Mahfoud Y, Alkhayer A, Simon P . Atrial fibrillation inpatient management patterns and clinical outcomes during the conflict in Syria: An observational cohort study. Perfusion. 2024; :2676591241259140. DOI: 10.1177/02676591241259140. View

17.

Piccini J, Simon D, Steinberg B, Thomas L, Allen L, Fonarow G . Differences in Clinical and Functional Outcomes of Atrial Fibrillation in Women and Men: Two-Year Results From the ORBIT-AF Registry. JAMA Cardiol. 2016; 1(3):282-91. DOI: 10.1001/jamacardio.2016.0529. View

18.

Antoun I, Alkhayer A, Kotb A, Barker J, Alkhayer A, Mahfoud Y . The prevalence and prognostic value of diabetes and hypertension in patients treated for cholera during the ongoing Syrian conflict. Clin Infect Pract. 2024; 23:100362. PMC: 11320765. DOI: 10.1016/j.clinpr.2024.100362. View

19.

Arora S, Patel P, Lahewala S, Patel N, Patel N, Thakore K . Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure. Am J Cardiol. 2017; 119(5):760-769. DOI: 10.1016/j.amjcard.2016.11.022. View

20.

Dagres N, Nieuwlaat R, Vardas P, Andresen D, Levy S, Cobbe S . Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol. 2007; 49(5):572-7. DOI: 10.1016/j.jacc.2006.10.047. View