Abstract 4141940: Outcomes in Middle Eastern Atrial Fibrillation Patients with Prior Ischemic Stroke/Systemic Embolism: Findings from the JoFib Study

Objective: Examine the sociodemographic and clinical profiles of Middle Eastern patients with atrial fibrillation (AF) who have a history of prior ischemic stroke or systemic embolism (SSE) and compare the risk of adverse events between AF patients from the Middle East with and without a history of SSE. Methods: The study population was drawn from the JoFib study, a multicenter, nationwide, prospective registry of AF patients from the Middle East. Patients with a history of prior hemorrhagic stroke were excluded from this analysis. The remaining patients were divided into two groups based on their history of prior SSE to compare baseline sociodemographic and clinical characteristics and the one-year risk of all-cause death, cardiovascular death, non-cardiovascular death, SSE, and major bleeding between AF patients with and without prior SSE. Multivariable Cox proportional hazards models and Fine-Gray sub-distribution hazards models were used to adjust for confounding factors. Additionally, multivariable logistic regression models were applied to compare the secondary outcome of clinically relevant non-major bleeding (CRNMB) between the two groups. Results: The study included 2,003 AF patients, divided into two groups: 318 patients (15.9%) with a history of prior SSE and 1,685 patients (84.1%) without. Patients with prior SSE were older than those without (45.3% vs. 30.4%, p<0.001). Compared to the no prior SSE group, those with prior SSE were less symptomatic (61.3% vs. 72.8%, p<0.001), had higher rates of diabetes (49.1% vs. 42.4%, p=0.03) and dyslipidemia (51.9% vs. 43.6%, p=0.007), and were less often obese (34.0% vs. 42.2%, p=0.009). Rhythm-control strategies were used less frequently in the prior SSE group (16.0% vs. 22.0%, p=0.02), while antithrombotic medications were more commonly used, including anticoagulants (89.0% vs. 80.7%, p<0.001) and antiplatelets (48.4% vs. 37.6%, p<0.001). The prior SSE group had a higher risk of all-cause death (aHR 1.64, 95% CI 1.21-2.22), cardiovascular death (adjusted subhazard ratio [aSHR] 1.50, 95% CI 1.04-2.16), non-cardiovascular death (1.76, 95% CI 1.00-3.08), and SSE (3.05, 95% CI 1.83-5.07). However, a history of prior SSE did not significantly affect the rates of major bleeding (0.67, 95% CI 0.27-1.65) or clinically relevant non-major bleeding (CRNMB) (AOR 0.79, 95% CI 0.47-1.33). Conclusion: AF patients with a history of prior SSE face a higher risk of adverse events compared to those without prior SSE.