Incidence of stroke and its association with metabolic abnormalities in patients with atrial fibrillation: The Jordan Atrial Fibrillation (JoFib) study

Abstract Background Evidence regarding the concomitant impact of multiple metabolic comorbidities on stroke risk in patients with atrial fibrillation is still equivocal. Despite the high prevalence of these comorbidities in the Middle East, no studies were conducted to predict their combined effect on stroke risk in patients with atrial fibrillation. This study aimed at identifying stroke incidence and the association between metabolic abnormalities and one-year risk of stroke in patients with atrial fibrillation. Methods: The study enrolled 2020 consecutive patients with atrial fibrillation. The incidence of stroke was compared across categories of different variables using the chi-square test. Two binary logistic regression models were developed to identify the significant predictors of stroke. Results: The 1-year incidence of stroke was 3.1%. Only diabetes was significantly associated with increased odds of stroke (OR = 2.15; 95% CI: 1.26, 3.66; p = 0.005) after adjusting for significant predictors of stroke including age, past history of stroke, and CHA2DS2VAS score. The combination of metabolic abnormalities was significantly associated with increased odds of stroke. The odds ratio increased from 2.53 (95% CI 1.10-8.85, P=0.028) for patients with only one metabolic abnormality to 3.90 (95% CI 1.16-13.10, P=0.028) for patients who had two metabolic abnormalities to 4.95 (95% CI 1.47-16.71, P=0.041) for patients with three metabolic abnormalities. Conclusion: Adequate glycemic control for patients with diabetes is crucial for patients with coexisting atrial fibrillation. Stroke prevention should focus on the concomitant impacts of multiple metabolic comorbidities rather than on a particular or single risk factor such as atrial fibrillation (AF). Comprehensive nursing assessment and management of coexisting metabolic abnormalities in patients with atrial fibrillation is substantial to minimize the stroke risk and prevent serious health complications. Nursing education helps patients with DM and hypertension to adhere to their treatment regimen, understand their condition, follow dietary restrictions, and seek medical attention if needed. Our findings postulate that the presence of multiple metabolic comorbidities may eliminate the effect of atrial fibrillation on stroke risk. Thus, further research is warranted to identify the coincident impact of multiple metabolic abnormalities on stroke risk in patients without atrial fibrillation.