Abstract 162: Treatment Patterns and Health Resource Utilization among Patients with Atrial Fibrillation in United Arab Emirates and Saudi Arabia

See related article, pages 227–230. Atrial fibrillation (AF) is not a benign cardiac arrhythmia but instead confers a 5-fold increased risk of stroke compared with age-matched people in sinus rhythm.1 AF patients also have a worse outcome after stroke, with elevated mortality and stroke recurrence rates,2 longer hospital stays,3 and lower discharge rates to their own homes.3 Current estimates suggest that AF afflicts ≈2.2 million Americans,4 whereas in the United Kingdom ≈740 000 individuals are thought to have AF,5 with >46 000 new cases being diagnosed each year.6 Given the increasing prevalence of AF and the associated thromboembolic complications, there are significant numbers of patients who require chronic oral anticoagulation (OAC). Current guidelines7,8 recommend that AF patients at moderate to high risk of stroke should be commenced on chronic anticoagulation with a vitamin K antagonist (VKA). These recommendations are based on data from meta-analyses of 13 randomized controlled trials which have demonstrated significant reductions in stroke9,10 and mortality10 with the use of warfarin. Despite the overwhelming evidence of the benefit of warfarin thromboprophylaxis in patients with AF, such therapy remains significantly underused. OAC care varies considerably from country to country and physicians tend to undertreat more than overtreat.11,12 Physicians’ dilemma of whether to prescribe warfarin is reflected in the recent Euro Heart Survey of AF patients, which revealed that only 67% of patients eligible for VKAs were actually prescribed it,13 although actual ‘real-life’ prescription of OAC may be significantly lower than this. So, why are eligible patients with AF not prescribed OAC? Warfarin itself is plagued by a number of inherent problems, the most important being the narrow therapeutic international normalized ratio (INR) window (target INR 2.5, range 2.0 to 3.0) which must be maintained, given that …

The epidemiological landscape and treatment efficacy of atrial fibrillation (AF) in the Middle East, notably in the United Arab Emirates (UAE), remain under-explored, presenting a distinct demographic and clinical pattern compared to Western populations. The FLOW-AF Registry aimed to bridge this knowledge gap by examining the characteristics, treatment patterns, clinical outcomes, and healthcare resource utilization (HCRU) of newly diagnosed non-valvular atrial fibrillation (NVAF) patients in the UAE, contributing to the scant literature on NVAF management in the region. This multicenter, prospective observational study enrolled patients diagnosed with NVAF across six sites in the UAE. Data were collected on demographics, medical history, treatment decisions, clinical outcomes, and HCRU over a 12-month observation period. A total of 198 patients were enrolled, with a mean age of 63.44 years. Mean CHA₂DS₂-VASc and HAS-BLED scores at baseline were 2.95 and 1.76, respectively. Most patients (55.77%) were prescribed non-vitamin K antagonist oral anticoagulants (NOACs). One-year incidence rates for major clinical events were 6.7% for all-cause mortality, 2.8% for bleeding complications, and 0.6% for myocardial infarction. No strokes were reported during the study period. The FLOW-AF Registry provides valuable insights into NVAF management in the UAE, demonstrating a distinct patient profile and a preference for NOACs. The NVAF cohort in the UAE was characterized by a younger demographic with lower risk scores and lower rate of clinical events relative to global counterparts. The findings underscore the evolving approach to AF management in the UAE, suggestive of a shift towards NOAC use but also highlights the need for ongoing research to fully understand long-term outcomes and validate current treatment paradigms in the UAE.

Atrial fibrillation is the most common cardiac arrhythmia, affecting 33.5 million patients globally. It is associated with increased morbidity, leading to significant clinical and economic burden. There exist only limited data in the Middle Eastern region from the existing registries. The goal of the FLOW-AF (atrial FibriLlatiOn real World management registry in the Middle East and Africa) registry is to evaluate the characteristics, treatment patterns, and clinical and economic outcomes associated with anticoagulation among patients newly diagnosed with nonvalvular atrial fibrillation in Egypt, Lebanon, the Kingdom of Saudi Arabia, and the United Arab Emirates. This study will be a multicountry, multicenter, prospective observational registry aiming to enroll 1446 newly diagnosed nonvalvular atrial fibrillation patients at more than 20 sites across the four countries. During the recruitment period, patients will be included if they were newly diagnosed with nonvalvular atrial fibrillation and had initiated treatment for the prevention of stroke/systemic embolism. Patient data will be assessed prospectively at 6 and 12 months from their enrollment date. Demographics, clinical characteristics, antithrombotic treatments received, clinical outcomes, adverse events, healthcare resource utilization, and direct costs associated with management of nonvalvular atrial fibrillation will be collected and analyzed overall, by country, and by groups created based on treatment, demographics, and clinical characteristics, medical history and risk factors. The FLOW-AF registry will provide information on the uptake of oral anticoagulants, treatment patterns, clinical outcomes, and healthcare utilization and costs among newly diagnosed nonvalvular atrial fibrillation patients in the Middle Eastern region.

POSTER PRESENTATIONS

First Confirmed Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection in the United States, Updated Information on the Epidemiology of MERS-CoV Infection, and Guidance for the Public, Clinicians, and Public Health Authorities—May 2014

Global warming is currently one of the world's most pressing issues. It has been a reason behind the proliferation of renewable energy (RE) systems. The majority of renewable energy sources are sustainable and release less carbon, in contrast to fossil fuels, which is why they have recently gained favour. Solar, wind, and geothermal energy have the potential to be employed in these Gulf countries to meet the region's power production needs. This is due to the Gulf country's strategic location as well as its immense oil and natural resource richness. According to previous researchers, the primary source of economic benefits for Gulf countries is global energy consumption by using crude oil and fossil fuels. The GCC is a major player in the global energy market. It is home to some of the world's largest oil and gas reserves and plays a significant role in producing and exporting energy resources. In future, as the world's energy needs shift towards renewable sources, the demand for traditional energy sources like oil and gas may decline. This could reduce the GCC's importance as a global energy supplier. Hence Saudi Arabia and the United Arab Emirates have made efforts to diversify their economies away from dependence on oil and gas exports. Saudi Arabia has launched several initiatives aimed at diversifying its economy. The most notable of these is the Vision 2030 program, which seeks to reduce the country's dependence on oil and create new economic sectors, such as tourism, entertainment, and technology. The government has also invested heavily in infrastructure projects, such as the construction of the NEOM megacity and the Red Sea Project, which are aimed at attracting foreign investment and creating new jobs. Similarly, the United Arab Emirates has been at the forefront of economic diversification, with its government launching several initiatives aimed at promoting innovation, entrepreneurship, and knowledge-based industries. One of the most notable initiatives is the Dubai Future Accelerators Programme, which brings together startups and government agencies to work on cutting-edge technologies and solutions. Additionally, the United Arab Emirates is investing heavily in renewable energy to generate 50% of its electricity from clean sources by 2050. Both Saudi Arabia and the United Arab Emirates are working towards building more diversified, knowledge-based economies that can compete in the global marketplace. At the same time, the road ahead may be challenging because of technical challenges, Economic challenges, lack of infrastructure, Regulatory challenges, Heavy Dependence on oil, Skilled labour shortage, and Regulatory environment. While taking the above as the context, the paper shall look at renewable energy development in Saudi Arabia and the United Arab Emirates. The following are major research questions which shall be explored and analysed: • How has the development of renewable energy technologies and infrastructure in Saudi Arabia and the United Arab Emirates progressed over time, and what factors have influenced this development? • What are the future plans and potential for continued growth and expansion of renewable energy in these countries? • What will be the future and potential renewable energy sources and policies in Saudi Arabia and the United Arab Emirates, and what are the barriers and opportunities for their adoption and integration into the energy mix? • How successful have Saudi Arabia and United Arab Emirates' economic diversification efforts been in reducing reliance on oil revenues? • What are the similarities and differences between the development of renewable energy technologies and policies in Saudi Arabia and the United Arab Emirates compared to the rest of the world? • What are the factors that have contributed to the similarities and differences, and how do they impact the potential for further growth and expansion of renewable energy in these countries relative to the rest of the world? This paper presents a literature-based study. The study covers capacities, projects, policies, and frameworks in Saudi Arabia and the United Arab Emirates. In this study, we would make use of secondary data that has been gathered from previously published statistics and relevant literature.

PCV182 - Treatment Patterns and Health Resource Utilization Among Atrial Fibrillation Patients in United Arab Emirates and Saudi Arabia

Limited data on atrial fibrillation (AF) are available from the Middle East and North Africa region (MENA). The aim of the FLOW-AF registry was to evaluate the characteristics, treatment patterns, and clinical and economic outcomes ofpatients with newly diagnosed non-valvular atrial fibrillation (NVAF) in MENA. This multi-center, prospective, observational study (the FLOW-AF registry) enrolled patients newly diagnosed with NVAF across Egypt, Lebanon, Kingdom of Saudi Arabia, and United Arab Emirates. The data collection occurred at enrollment (baseline) and after 6- and 12-months (follow-up). Baseline data included demographics, AF characteristics, medical history, and anti-thrombotic treatment patterns. Clinical events, healthcare resource utilization, and direct costs were collected at follow-up. The study enrolled a total of 1418 patients (52.7% males and 47.3% females). The mean age of the patients was 64.5years and 90.6% were white. The mean (standard deviation) CHA2DS2-VASc and HAS-BLED risk scores were 2.7 (1.6) and 1.6 (1.2), respectively. Non-vitamin K antagonist oral anticoagulants, antiplatelet therapy, and vitamin K antagonists were prescribed to 65.8%, 16.4%, and 12.9% patients, respectively. During follow-up, the following rates of clinical outcomes were observed: bleeding events (1.7%), transient ischemic attack (1.7%), all-cause mortality (1.7%), stroke (0.6%), myocardial infarction (0.2%), and systemic embolism (0.08%). This MENA patient population was younger and had lower mean baseline CHA2DS2-VASc and HAS-BLED scores. The rates of clinical outcomes over 1-year in this study were low. Longer follow-up is required to comprehensively assess clinical outcomes in this patient population.

<p>This study aims to identify the reality of a Total Quality Management (TQM) system and the level of its application on a sample of hospitals in Jordan and United Arab Emirates (UAE), together with determining the differences between both the Jordanian hospitals and UAE hospitals in their application of TQM. It also aims to identify the monetary and non-monetary incentives in hospitals, and to study the role of each dimension of various TQM dimensions on monetary and non-monetary incentives. A total of 160 questionnaires were distributed in six hospitals that were selected using a convenient sampling method. A total of 129 questionnaires were received, 74 of them were from Jordanian hospitals and 55 questionnaires were from UAEs hospitals. The participants were doctors, nurses, technicians, and administrators of six hospitals in Jordan and the UAE. An independent samples T-test and multiple regression analysis was used to test the hypotheses. The results showed that the application of TQM in both Jordanian and UAE hospitals was good, of a high level, and with a relative advantage for UAE hospitals. The results also showed that the incentives in Jordanian hospitals were generally better than those of the UAE hospitals, particularly in terms of the monetary incentives, while non-monetary incentives were the advantage for UAE hospitals. Moreover, it was found that only one dimension of the TQM dimensions, the participation of employees, had a significant effect on the monetary and non-monetary incentives in each of the Jordanian and the UAE hospitals (P value ≤ 0.05). While the rest of the dimensions of TQM (focus on the customer, continuous improvement, top management commitment, and teamwork) had no significant effect on both monetary and non-monetary incentives in both the Jordanian and the UAE hospitals.</p>

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