Atrial Fibrillation Inpatient Management Patterns and Clinical Outcomes During The Conflict In Syria: An Observational Cohort Study

Background Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there is no data on AF inpatient management strategies and clinical outcomes in Syria. Objectives This study aims to navigate AF inpatient management and cardiovascular (CV) mortality in a tertiary cardiology centre in Latakia, Syria. Methods A single-centre retrospective observational cohort study was conducted at Tishreen’s University Hospital, Latakia, Syria, from June 2021 to June 2023. We included patients ≥16 years of age presenting and being treated for AF as the primary diagnosis at the emergency department. Medical records were examined for patient demographics, laboratory results, treatment plans and inpatient details. Inpatient cardiovascular mortality was the primary outcome of interest. Results The study included 596 patients. The median age was 58 and 61% were males. Only 121 patients (20.3%) were known to have AF. Rhythm control strategy was persuaded in 39% of patients, with Amiodarone being the only agent utilised while the rest adopted a rate control approach. CV Mortality occurred in 28 patients (4.7%). The presence of smoking (aOR: 1.6, 95% CI: 1.3 to 2.1, P=0.04), thyroid disease (aOR= 9.7, 95% CI= 1.2 to 91.6, P<0.001), COPD (aOR: 82, 95% CI: 12.7 to 711, P<0.001) and valvular heart disease (VHD) (aOR= 9.1, 95% CI: 1.7 to 55.1, P<0.001) were independent risk factors of cardiovascular inpatient mortality. Conclusion Current smoking, thyroid disease, COPD and VHD were independent risk factors of inpatient cardiovascular mortality with AF in Syria. Elective rhythm control was challenging due to limited resources.