Introduction Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in clinical practice with a progressively increasing incidence and prevalence worldwide. Despite the prominent morbidity and mortality associated with AF, no previous studies have compared the clinical characteristics between hospitalized patients (H-pts) and ambulatory care patients (A-pts) with AF. The purpose of this cross-sectional study is to compare the epidemiology and clinical characteristics among patients with AF in both hospitalized and ambulatory settings.

Methods 2,157 consecutive adult patients newly diagnosed with AF while hospitalized or during outpatient visits in 19 hospitals and 30 outpatient cardiology clinics were enrolled in the Jordan AF study from May 2019 to January 2021. Clinical and epidemiological characteristics of H-pts at the time of enrollment were compared to the A-pts.

Results Among the 2157 pts, 628 (29.1%) of participants were H-pts at the time of enrollment, with the most common cause of hospitalization being due to AF-related morbidity (29.5%). While no statistically significant association was observed with gender, H-pts were slightly older (mean age 69.7±14.1 years vs 67.1±12.4 years, p<0.001), had a higher prevalence of diabetes (52.5% vs 40.7%, p<0.001) and dyslipidemia (51.2% vs 42.0%, p<0.001). Furthermore, they had higher prevalence of cerebrovascular accident (20.1% vs 13.6%, p=0.001), coronary artery disease (17.4% vs 8.4%, p<0.001), heart failure (31.1% vs 21.4%, p<0.001), and a left ventricular ejection fraction of <40% (16.6% vs 12.8%, p=0.02). H-pts had a significantly less prevalent valvular AF (VAF) in contrast to A-pts (4.4% vs 10.3%, p<0.001). Notably, both the CHA2DS2VASc and HAS-BLED scores were significantly higher in H-pts with a mean of 4.0±1.9 and 2.01±1.2, respectively, compared to mean scores of 3.41±1.7 and 1.51±1.1, respectively, in A-pts (p<0.001). Additionally, H-pts had a higher prevalence of high-risk CHA2DS2VASc score of ≥2 (89.2% vs 84.7%, p=0.006). Among patients with NVAF in both groups, oral anticoagulant agents (OAC) were utilized in 64.8% and 81.2% of the H-pts and A-pts groups, respectively (p<0.001). Novel OAC (NOAC) were the most commonly used OAC in patients with NVAF, accounting for 44.0% and 52.3% of H-pts and A-pts, respectively (p=0.001).

Conclusion The JoFib study demonstrated significant variability among AF patients enrolled at the time of hospitalization compared to those enrolled in an outpatient setting. H-pts were older and had more comorbidities including higher CHA2DS2VASc and HAS-BLED scores. The Utilization of OAC and NOAC was less among H-pts with NVAF compared to the A-pts group. Patients with the mentioned profile need to be identified earlier while outpatient and be given special attention and management to avoid hospitalization and AF complication.

Conflict of Interest None declared.