Atrial Fibrillation Screening in Syrian Patients Reporting to the Emergency Department During the Ongoing Conflict: a Cross-sectional Study

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2025 Mar 7

PMID 40051433

Authors

Ibrahim Antoun

Alkassem Alkhayer

Aref Jalal Eldin

Alamer Alkhayer

Ibrahim Salama

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. Data regarding AF screening in conflict countries' emergency departments (ED) is lacking.

Methods: We included consecutive patients >40 years old who reported to the ED of a Syrian tertiary centre between July 2024 and September 2024. Patients had routine 12-lead electrocardiograms (ECGs) regardless of presenting complaints. Two cardiology consultants blindly verified ECG findings. We excluded critically unwell patients and ECG discrepancies between the two consultants. Data were taken from patients' medical notes.

Results: The final analysis included 694 patients, 101 (15%) had AF on the ECG. The most common presenting complaints and ECG abnormality were trauma (44%) and sinus tachycardia (15%), respectively. Compared to the rest of the patients, AF patients were older (66 vs. 59 years; < 0.001), had a lower proportion of males (39% vs. 54%; = 0.01), a higher prevalence of diabetes mellitus (49% vs. 21%; = 0.01), and more cases of congestive cardiac failure (CCF) (38% vs. 17%; < 0.001). AF patients also had a higher CHA₂DS₂-VASc score (3 vs. 2; < 0.001). CCF [odds ratio [OR]: 3.3, 95% confidence interval [CI]: 1.5-6.4, < 0.001] and a higher CHA₂DS₂-VASc score(OR: 4, 95% CI: 1.6-7.7, < 0.001) were independently associated with positive AF screening.

Conclusion: 15% of patients reporting to this Syrian ED had positive AF screening. CCF and CHA₂DS₂-VASc scores are predictive of AF.

References

Lowres N, Neubeck L, Salkeld G, Krass I, McLachlan A, Redfern J . Feasibility and cost-effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb Haemost. 2014; 111(6):1167-76. DOI: 10.1160/TH14-03-0231. View

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

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

Lahewala S, Arora S, Patel P, Kumar V, Patel N, Tripathi B . Atrial fibrillation: Utility of CHADS and CHADS-VASc scores as predictors of readmission, mortality and resource utilization. Int J Cardiol. 2017; 245:162-167. DOI: 10.1016/j.ijcard.2017.06.090. View

Fitzmaurice D, Hobbs F, Jowett S, Mant J, Murray E, Holder R . Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ. 2007; 335(7616):383. PMC: 1952508. DOI: 10.1136/bmj.39280.660567.55. View

Healey J, Connolly S, Gold M, Israel C, Van Gelder I, Capucci A . Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012; 366(2):120-9. DOI: 10.1056/NEJMoa1105575. View

Antoun I, Alkhayer A, Aljabal M, Mahfoud Y, Alkhayer A, Simon P . Thirty-day unplanned readmissions following hospitalization for atrial fibrillation in a tertiary Syrian center: A real-world observational cohort study. Heart Rhythm O2. 2025; 5(12):854-859. PMC: 11721721. DOI: 10.1016/j.hroo.2024.05.010. 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

Godin R, Yeung C, Baranchuk A, Guerra P, Healey J . Screening for Atrial Fibrillation Using a Mobile, Single-Lead Electrocardiogram in Canadian Primary Care Clinics. Can J Cardiol. 2019; 35(7):840-845. DOI: 10.1016/j.cjca.2019.03.024. View

10.

Leyh B, Gispen M . Access to Medicines in Times of Conflict: Overlapping Compliance and Accountability Frameworks for Syria. Health Hum Rights. 2018; 20(1):237-250. PMC: 6039728. View

11.

Curry S, Krist A, Owens D, Barry M, Caughey A, Davidson K . Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement. JAMA. 2018; 320(5):478-484. DOI: 10.1001/jama.2018.10321. View

12.

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

13.

Morgan S, Mant D . Randomised trial of two approaches to screening for atrial fibrillation in UK general practice. Br J Gen Pract. 2002; 52(478):373-4, 377-80. PMC: 1314292. View

14.

Kahwati L, Asher G, Kadro Z, Keen S, Ali R, Coker-Schwimmer E . Screening for Atrial Fibrillation: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2022; 327(4):368-383. DOI: 10.1001/jama.2021.21811. View

15.

Nguyen T, Hilmer S, Cumming R . Review of epidemiology and management of atrial fibrillation in developing countries. Int J Cardiol. 2013; 167(6):2412-20. DOI: 10.1016/j.ijcard.2013.01.184. View

16.

Scott P, Pancioli A, Davis L, Frederiksen S, Eckman J . Prevalence of atrial fibrillation and antithrombotic prophylaxis in emergency department patients. Stroke. 2002; 33(11):2664-9. DOI: 10.1161/01.str.0000035260.70403.88. View

17.

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

18.

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

19.

Svennberg E, Engdahl J, Al-Khalili F, Friberg L, Frykman V, Rosenqvist M . Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation. 2015; 131(25):2176-84. DOI: 10.1161/CIRCULATIONAHA.114.014343. View

20.

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