RESUMEN
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding readmission for new congestive heart failure (CHF) following index admission for AF in the developing world are poorly described. OBJECTIVES: The study aimed to assess the rate, predictors, and outcomes of 120-day CHF readmission after index admission for AF in Syria. METHODS: This retrospective cohort study collected all adult patients without known CHF who had an index admission with AF to Latakia's tertiary center between June 2021-December 2023. Data were taken from patients' medical notes. The primary outcome included readmission with incident CHF within 120 of index discharge, and secondary outcomes included predictors and outcomes of these CHF readmissions. RESULTS: A total of 660 patients were included in the final analysis, of which 69 (11.7%) were readmitted with new CHF within 120 days of index discharge. Readmitted patients had higher median age (58 vs 70 years, p < .001). Factors that independently increased 120-day CHF incidence were age ≥60 years (HR: 9.8, 95% CI: 4.8-23.6, p < .001), diabetes mellitus (DM) (HR:2.9, 95% CI:1.7-4.9, p < .001), valvular heart disease (VHD) (HR:1.7, 95% CI:1.04-2.78, p = .047), and hypertension (HR:2.5, 95% CI:1.5-4, p < .001). Inpatient mortality occurred in six readmitted patients (9%). LVEF <40% (HR:6.7, 95% CI: 24.31, p = .01) and DM (HR:7.2, 95% CI: 1.9-33, p = .004) were independently associated with inpatient mortality. CONCLUSION: Hospitalization for new CHF was common in Syrian patients discharged with AF. The clinical predictors of incident CHF emphasize the importance of integrated management of lifestyle risk factors and common comorbidities in AF patients to optimize outcomes in resource-depleted communities.
RESUMEN
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: The study aims were to review the inpatient management of patients with AF and assess 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. Patients ≥16 years of age presenting and being treated for AF as the primary diagnosis with or without a thromboembolic event were included. Medical records were examined for patients' demographics, laboratory results, treatment plans and inpatient details. Studied outcomes include inpatient all-cause and CV mortality, ischemic and bleeding events, and conversion to sinus rhythm (SR). RESULTS: The study included 596 patients. The median age was 58, and 61% were males. 121 patients (20.3%) were known to have AF. A rhythm control strategy was pursued in 39% of patients. Ischemic and bleeding events occurred in 62 (11%) and 12 (2%), respectively. CV and all-cause mortality occurred in 28 (4.7%) and 31 patients (5%), respectively. The presence of valvular heart disease (VHD) (adjusted odds ratio (aOR) = 9.1, 95% confidence interval (CI): 1.7 to 55.1, p < .001), thyroid disease (aOR: 9.7, 95% CI = 1.2 to 91.6, p < .001) and chronic obstructive pulmonary disease (COPD) (aOR: 82, 95% CI: 12.7 to 71, p < .001) were independent risk factors of increased CV inpatient mortality. CONCLUSION: Syrian inpatients admitted with AF in Latakia are relatively younger than those in other countries. Active thyroid disease, COPD and VHD were independent risk factors of inpatient CV mortality with AF.
RESUMEN
Objectives: Little work has been done investigating the prevalence and impact of comorbidities on cholera outcomes within conflict settings. We describe the clinical outcomes of patients treated for cholera in Latakia, Syria, during the 2022-2023 cholera outbreak. Methods: We performed a single-centre retrospective observational cohort study of patients admitted to the hospital with suspected cholera between 15th December 2022 and 15th February 2023 at National Hospital, Latakia, Syria. Multivariable negative binomial regression analysis was used to investigate the variables' relationship to hospital length of stay. Results: The study involved 89 patients admitted to the hospital; none were vaccinated against cholera. Cholera rapid diagnostic test was positive in 91 % of patients. Half of the patients (51 %) were male; a third (35 %) had hypertension, and a fifth (19 %) had diabetes. One patient passed away during admission. Patients who were male, had diabetes and were hypertensive tended to have longer hospital stays in univariable analysis. When these factors were added to a multivariable negative binomial model (consisting of age, gender, hypertension and diabetes), male sex (IRR: 4.1, 95 % CI: 1.28-6.2, p = 0.001), the presence of hypertension (IRR: 2.1,95 % CI: 1.14 to 4.1, p = 0.004) and diabetes (IRR: 2, 95 % CI: 1.2 to 2.7, p = 0.001) were independent predictors of longer hospital stays. Conclusion: In conflict settings, hypertension and diabetes are common in patients admitted to hospital with cholera and are associated with longer hospital stays. Mortality from cholera, however, was low. Our findings highlight the importance of comorbidity control in mitigating excess morbidity during infectious disease outbreaks within conflict areas.