ATRIAL FIBRILLATION IN YOUNG PATIENTS: ANALYSIS FROM THE JORDAN ATRIAL
FIBRILLATION REGISTRY
Abstract
Introduction: Atrial fibrillation (AF) is the most common sustained
arrhythmia with an increasing incidence and prevalence in older age
groups compared to younger individuals and the general population.
Younger patients with AF often have different clinical characteristics,
risk factors, and outcomes. Because AF among the young has not been
studied in Middle Eastern populations, we conducted this study to
provide valuable insights into the differences in the baseline clinical
characteristics and the one-year adverse events between young and older
AF patients, and thus contribute to formulate future treatment
strategies and improve health outcomes. Methods: Consecutive adult
patients previously or newly diagnosed with AF in 30 hospitals and
out-patient cardiology clinics were enrolled in the Jordan AF study from
May 2019 to October 2020. All patients were followed-up for one year.
Baseline clinical characteristics and the one-year adverse events were
assessed in young (<50 years) and older (≥ 50 years) adult
patients with AF. Results: Of the 2020 AF patients enrolled in the
study, 201 (10%) were young. Young patients were more likely to be men
(75.6% vs. 43.8%, p<0.001), and had a lower prevalence of
hypertension (31.3% vs. 79.3%, p<0.001), diabetes mellitus
(10.4% vs. 47.2%, p<0.001), and previous stroke (9.0% vs.
16.1%, p=0.027) compared to older patients. Furthermore, young patients
had a lower mean CHA 2DS 2-VASc score
(1.1±1.4 vs. 3.9±1.7, p<0.001) and mean HAS-BLED score
(0.6±0.7 vs. 1.8±1.1, p<0.001). The use of oral anticoagulant
agents was significantly lower in young patients (39.3% vs. 75.0%,
p<0.001). Young patients also had lower one-year all-cause
mortality (1.1% vs. 13.7%, p=0.001), cardiovascular mortality (1.1%
vs. 7.7%, p=0.04) and major bleeding (0% vs. 2.7%, p=0.021) compared
to older patients. The rate of stroke and systemic embolization was
similar in both groups (3.4% vs. 4.4%) Conclusion: The findings of the
Jordan AF study suggest that young patients (<50 years of age)
comprise a small proportion (10%) of the overall AF patient population.
They had more favorable baseline clinical characteristics and risk
scores compared to older patients. The one-year mortality and major
bleeding rates in young patients were also lower than that in older
patients.