Effect of conflict on atrial fibrillation outcomes in the Middle East: Multicenter international cohort study

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Background Atrial fibrillation (AF) outcomes vary depending on the stability of the healthcare system. Objectives This study compares AF outcomes in two neighbouring Levant countries in th: Syria, a conflict-affected country, and Jordan, a country with a stable healthcare system. Methods We conducted a retrospective observational cohort study of AF patients from Tishreen University Hospital, Syria, and the Jordanian AF (JoFib) Registry. Propensity score matching was performed to adjust for baseline characteristics. Primary outcomes included one-year readmission rates and one-month cerebrovascular events (CVAs) or major bleeding. Results The study included 2,677 patients (657 from Syria and 2,020 from Jordan). Syrian patients were younger (median age: 60 vs. 70 years, p<0.001) and had higher rates of smoking (39% vs. 14%, p<0.001) and ischemic heart disease (26% vs. 12%, p<0.001) but lower rates of hypertension and diabetes. One-year readmission rates were significantly higher in Syria (64% vs. 9%, p<0.001), as were one-month CVAs (3% vs. 1%, p<0.001) and major bleeding (4% vs. 0.5%, p<0.001). These differences remained significant after propensity score matching. Compared to Jordanian patients, Syrian patients were associated with a substantial increase in all-cause readmission (OR: 1.8, 95% CI: 1.5–2.6, p<0.001). Furthermore, Syrian patients had a considerable rise in one-month CVA (OR: 6.5, 95% CI: 2.5–16.5, P<0.001) and major bleeding (OR: 20.6, 95% CI: 6.7–63.3, p<0.001). Conclusion AF outcomes are significantly worse in Syria compared to Jordan. Healthcare system disruptions contribute to increased readmissions and complications. Strengthening AF management in conflict zones through improved access to medications and structured follow-up is essential to mitigating adverse outcomes.

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