Limitations
Few limitations of the study are worth mentioning. Observational, non-interventional studies have inherently potential bias of residual confounding, incomplete data collection and potentially limited patient’s recall of events and complications. Recruiting consecutive patients could have overcome bias in enrollment. Furthermore, the fact that the major cardiovascular events evaluated in this study were hard endpoints, such as death, stroke, ACS, coronary revascularization, and major bleeding, makes recall issues by patients very unlikely. Generalizability of the results of this to all countries in the region might be limited because our cohort was recruited from tertiary care centers and cardiology clinics in one country. Other limitations are the relatively short follow up period and the arbitrary choice of the cutoff value for age. These values differ between studies which may result in difficulty in comparing results between studies. Larger, multicenter studies involving several countries with larger sample sizes and longer follow-up may provide a more comprehensive understanding of the prevalence, risk factors, and outcomes of AF in the Middle Eastern region. Despite these limitations, this study contributes to the contemporary knowledge concerning young patients with AF who have not been studied previously in the Middle East and provides important insights into the burden of AF in the Middle Eastern region and the need for increased attention and resources towards its prevention, early detection, and management in young individuals.