Abstract
Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and accounts for one-third of hospitalizations for cardiac disturbances. The majority of data on management of AF patients are from western countries, with limited information available from the Middle East region. The objective of this study was to characterize treatment patterns and health resource utilization among AF patients in the Kingdom of Saudi Arabia (KSA) and United Arab Emirates (UAE). METHODS: A retrospective chart review was undertaken at three hospitals in UAE and three in KSA, to identify AF patients diagnosed between January 2005 and June 2010. Patient charts were sampled consecutively backwards by diagnosis date, from June 2010 until the target sample was reached. AF was identified based on ICD-9 code (427.31), from a sample of patients defined by any history of anticoagulant use. Data on demographic and disease-related characteristics, treatment patterns, health resource utilization, and international normalized ratio (INR) control were abstracted from diagnosis until June 2012. AF was categorized as chronic (persistent, long-standing or permanent) or paroxysmal. RESULTS: Among eligible AF patients (UAE, n=157, KSA, n=152), the mean age at diagnosis was 69 years in UAE and 66 years in KSA. Male patients comprised 52.9% of the UAE sample and 48.7% of the KSA sample. The majority were diagnosed with chronic AF (80.9% in UAE, 63.7% in KSA) and had a CHADS 2 score ≥2 at diagnosis (77.1% in UAE, 71.1% in KSA). Treatments prescribed to AF patients differed between countries: warfarin monotherapy was widely used in UAE (59.9%); while a variety of warfarin- and aspirin-based combination therapies were used in KSA, with no single dominant regimen. Warfarin + bisoprolol (12.5%) and aspirin + bisoprolol (10.5%) combination therapies were the most common regimens in KSA. Patterns of health care utilization also varied. In KSA, 29.6% of patients were hospitalized, and 30.9% visited the emergency room, compared to 8.9% and 11.5%, respectively, in UAE. Outpatient visits were more frequent in UAE, with a mean of 1.0 visits per patient per year, compared to 0.3 visits per patient per year in KSA. In both regions, the most common clinical outcome was ischemic/unspecified stroke, with an incidence of 7.0% in UAE and 5.3% in KSA. CONCLUSIONS: Patients with AF in UAE and KSA were relatively young compared to age distributions reported in other regions. Treatments and health resources used by AF patients varied between KSA and UAE. Warfarin monotherapy was widely used in UAE, while a variety of monotherapy and combination therapy regimens were used in KSA. Health care resource utilization was high in this population, particularly hospitalization rates in KSA. While some differences may result from differences in patient and disease characteristics, they likely also reflect variation in management strategies across the regions.
Published Version
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