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.