Wael Almahmeed

Clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with heart failure: an observational report from the Middle East

Objectives The purpose of this study is to report the prevalence, clinical characteristics, precipitating factors, management and outcome of patients with prior stroke hospitalised with acute heart failure (HF). Design Retrospective analysis of prospectively collected data. Setting Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicentre study of consecutive patients hospitalised with acute HF in 2012 in seven Middle Eastern countries and analysed according to the presence or absence of prior stroke; demographics, management and outcomes were compared. Participants A total of 5005 patients with HF. Outcome measures In-hospital and 1-year outcome. Results The prevalence of prior stroke in patients with HF was 8.1%. Patients with stroke with HF were more likely to be admitted under the care of internists rather than cardiologists. When compared with patients without stroke, patients with stroke were more likely to be older and to have diabetes mellitus, hypertension, atrial fibrillation, hyperlipidaemia, chronic kidney disease, ischaemic heart disease, peripheral arterial disease and left ventricular dysfunction (p=0.001 for all). Patients with stroke were less likely to be smokers (0.003). There were no significant differences in terms of precipitating risk factors for HF hospitalisation between the two groups. Patients with stroke with HF had a longer hospital stay (mean±SD days; 11±14 vs 9±13, p=0.03), higher risk of recurrent strokes and 1-year mortality rates (32.7% vs 23.2%, p=0.001). Multivariate logistic regression analysis showed that stroke is an independent predictor of in-hospital and 1-year mortality. Conclusions This observational study reports high prevalence of prior stroke in patients hospitalised with HF. Internists rather than cardiologists were the predominant caregivers in this high-risk group. Patients with stroke had higher risk of in-hospital recurrent strokes and long-term mortality rates. Trial registration number NCT01467973.

PREVALENCE AND OUTCOMES OF RECURRENT HOSPITAL ADMISSIONS IN PATIENTS WITH ATRIAL FIBRILLATION: INSIGHTS FROM THE GULF SURVEY OF ATRIAL FIBRILLATION EVENTS (GULF SAFE) REGISTRY

Methods: We analyzed data from the Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) Registry, a prospective, multinational emergency room (ER)-based study in 23 hospitals in 6 Middle Eastern Arab countries recruited patients identified with AF in ERs of participating sites between October 2009 and June 2010. Patients were followed during stay in hospital or ER until discharge and subsequently for 12 months.

Chronic obstructive airway disease among patients hospitalized with acute heart failure; clinical characteristics, precipitating factors, management and outcome: Observational report from the Middle East

Background: The purpose of this study was to report the prevalence, clinical characteristics, contributing factors, management and outcome of patients with chronic obstructive pulmonary disease (COPD) among patients hospitalized with heart failure (HF). Methods: Data were derived from Gulf Care (Gulf acute heart failure registry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute heart failure during February to November 2012 in seven Middle Eastern countries. Data were described and compared for demographics, management and outcomes. Results: The prevalence of COPD among HF patients was 10%. COPD patients were older, more likely to be female and to have diabetes, hypertension, chronic kidney disease and sleep apnea (P = 0.001 for all) when compared to non-COPD patients. Contributing factors for hospitalization were systemic infection and atrial arrhythmias in COPD patients compared to acute coronary syndrome, uncontrolled hypertension and anemia in the non-COPD patients. Left-ventricular ejection fraction was higher in COPD patients; while BNP levels were comparable between the two groups. Non-invasive ventilation was used more frequently among COPD patients compared to non-COPD patients (P = 0.001). On multivariate logistic regression analysis, COPD was not associated with increased risk in-hospital and one-year death among acute heart failure (AHF) population and β blockers treatment appear to have neutral mortality effect in COPD patients with HF. Conclusion: COPD have distinct cardiovascular risk profile and precipitating factors for hospitalization with HF when compared to non-COPD patients. COPD history had no impact on the short-term and one-year mortality.

THE EFFECT OF FEMALE GENDER ON CARDIAC ARRHYTHMIAS IN ACUTE CORONARY SYNDROMES: INSIGHTS FROM THE SECOND GULF REGISTRY OF ACUTE CORONARY EVENTS

Little is known about the effect of female gender on cardiac arrhythmias in patients with acute coronary syndromes (ACS). Accordingly, we sought to assess the effect of gender on the incidence and in-hospital mortality of patients with clinically significant arrhythmias (CSA) in a multicenter

Impact of in-hospital recurrent ischemia event: findings from GULF RACE-2

Background Little in the literature is known about the long term outcome of patients with acute coronary syndrome (ACS) and in-hospital recurrent ischemic event. Accordingly; our objectives were to determine the baseline characteristics of patients, the predictors, and the long term outcome of patients with recurrent ischemia. Methods The population compromised 7930 enrolled in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Results Out of the 7930 ACS patients, 172 (2.2%) had Re-MI during their hospital stay. Patients with Re-MI were more likely to be older (mean age 59.12xa0±xa013.5 vs. 56.8xa0±xa012.4, Pxa0=xa00.016), had significantly higher rate of prior history of angina (48% vs. 38.2%, Pxa0=xa00.006), and hyperlipidemia (45.2% vs. 37.3%, Pxa0=xa00.027) than patients without Re-MI. On admission patients with Re-MI had significantly higher HR, lower systolic BP, Killip class 4 and high GRACE risk score than those without Re-MI (27.3% vs. 17.6%), (11% vs. 4.8%), (8.1% vs. 3.2%), and (31.8% vs. 21.5%, Pxa0 Conclusion Recognizing patients at high risk of Re-MI is important as modifying the risk factors, and managing the patient aggressively may reduce the incidence of such events and the associated morbidity and mortality.

OP-003: SHORT AND LONG-TERM MORTALITY ASSOCIATED WITH VENTRICULAR ARRHYTHMIA IN PATIENTS HOSPITALIZED WITH ACUTE CORONARY SYNDROME. FINDINGS FROM THE GULF RACE REGISTRY-2

Methods and results The Second Gulf Registry of Acute Coronary Events (Gulf RACE-2) is a multinational observational study of patients with ACS, which enrolled 7930 patients. Of these, 333 (4.2%) developed VA during hospitalization. Patients with VA were significantly older (mean age 58.3 vs. 56.8 years), and had a significantly higher rate of prior stroke/transient ischemic attack (7.5 vs. 4.2%), smoking (36.6 vs. 35.6%), congestive heart failure (11.0 vs. 6.5%), and peripheral artery disease (6.5 vs. 1.7%), compared with patients without VA. They had significantly less diabetes mellitus (35.4 vs. 40.3%), hypertension (43.2 vs. 47.9%), percutaneous coronary intervention (6.1 vs. 9.4%), and dyslipidemia (22.4 vs. 38.2%). The adjusted odds ratios for in-hospital, 30-day, and 1-year mortality in VA complicating all ACS were 25.8, 11.1, and 7.3; STelevation myocardial infarctions were 18.3, 11.7, and 6.3; and unstable angina and non-ST elevation myocardial infarctions were 47.4, 10.3, and 18.7, respectively (all P<0.001). Conclusion In-hospital VA in patients with ACS with and without ST elevation was associated with significantly higher in-hospital, 30-day, and 1-year mortality. Noticeably higher long-term mortality among Middle Eastern patients with ACS having VA compared with other reports requires further study and warrants immediate attention. Coron Artery Dis 24:160–164 !c 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.