Ayman Hammoudeh1, Nazih Kadri2, Liza Shaban3, Abdelrahman Obeidat3, Mohammad Jarrah4, Rashid Ibdah4, Eyas Al-Mousa1, Fatima Al-Nadi1, Ramzi Tabbalat2, Imad A. Alhaddad5

1Istishari Hospital, Amman, Jordan, 2Abdali Hospital, Amman, Jordan, 3Jordan University Hospital, Amman, Jordan, 4King Abdullah University Hospital, Irbid, Jordan, 5Jordan Hospital Medical Center, Amman, Jordan

Background:
Clinical practice guidelines for the use of oral anticoagulant medications (OACs) in patients with nonvalvular atrial fibrillation (NVAF) and valvular AF (VAF) continue to evolve. Adherence to the most recent guidelines in Middle Eastern patients with AF has not been studied. We sought to study the use of the direct OAC medications (DOACs) and vitamin K antagonists (VKA) according to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline in patients with AF in a Middle Eastern country.

Method(s):
We analyzed interim data from the ongoing multicenter prospective Jordan AF (JoFib) Study to evaluate the baseline clinical profiles, CHA2DS2-VASc score and use of OACs in patients with NVAF or VAF. Patients were > 18 years of age with documented AF and enrolled in an ambulatory or in-patient setting.

Result(s):
.  Of 1837 patients enrolled to date (of a target of 2000 patients), 1686 (91.8%) patients had NVAF and 151 (8.2%) had VAF. Compared with VAF group, those in the NVAF group were older (mean age 68.2±13.4 years vs. 61.3±11.8 years, p<0.0001), and more likely to be men (48.7 vs. 35.8%, p=0.003), to have hypertension (76.5% vs. 53.6%, p<0.001) and diabetes mellitus (45.0% vs. 29.8%, p<0.001). In the VAF group, 95.4% were prescribed VKA (Class I recommendation). Overall, more DOACs (531 patients, 67.4%) than VKA (257 patients, 32.6%) were prescribed in patients with NVAF (Class I recommendation). Furthermore, of 1274 NVAF patients eligible for anticoagulation with CHA2DS2-VASc score >3 in women and >2 in men, OACs were prescribed for 1127 patients (88.5%) including 65.4% who received DOACs (class I recommendation) and 34.6% VKA. In 176 women with CHA2DS2-VASc score 2 and men with score 1, OACs were prescribed for 134 patients (76.1%), including DOACs in 70.9% (Class IIb recommendation). Omitting OACs in 131 women with score of 1 and men with score of 0 (Class IIa recommendation) was observed in 88 patients (67.2%) and the other 43 patients (32.8%) received OACs.

Conclusion(s):
The majority of AF patients in this Middle Eastern study had NVAF. A high level of adherence to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline was observed. About 7/10 and 9/10 of patients with NVAF and VAF, respectively, were prescribed OACs. DOACs were prescribed for about 2/3 of eligible AF patients. The impact of this finding on the incidence of adverse thromboembolic events awaits the one year follow up.