Comorbidity phenotypes, prognostic implications, and Atrial fibrillation Better Care pathway effectiveness in patients with early-onset atrial fibrillation: A latent class analysis from the Tianjin Atrial Fibrillation Project.

BACKGROUND

Patients with early-onset atrial fibrillation (AF) exhibit heterogeneous comorbidity profiles, but they have long been overlooked.

OBJECTIVE

This study aimed to identify comorbidity phenotype clusters in younger patients with AF and evaluate prognosis and effectiveness of holistic or integrated care management based on the Atrial fibrillation Better Care (ABC) pathway among different phenotypes.

METHODS

In this study from the Tianjin Atrial Fibrillation Project, latent class analysis was conducted to determine comorbidity phenotypes in patients with AF aged 18-45 years. We investigated the associations between the comorbidity phenotypes, AF management strategies, and prognosis. The primary outcome was the composite of all-cause death and major adverse cardiovascular events.

RESULTS

We included 3573 patients with early-onset AF (mean age, 38.68 ± 5.82 years; 781 [21.9%] female). 3 phenotype clusters were identified: (1) cluster 1: low complexity (n = 1897, 53.1%); (2) cluster 2: multiple cardiovascular metabolic comorbidities (n = 1037, 29.0%); and (3) cluster 3: structural heart disease (n = 639, 17.9%). During a median follow-up of 1408 days (interquartile range, 496-2532), the risk of the primary outcome was higher in cluster 2 (hazard ratio [HR], 1.94; 95% confidence interval [Cl], 1.56-2.42; P < .001) and 3 (HR, 2.63; 95% Cl, 2.15-3.20; P < .001), compared with cluster 1. ABC pathway adherence (n = 1186 [33.2%] patients) was associated with reduced risk of the primary outcome overall (HR, 0.47; 95% Cl, 0.40-0.56; P < .001), with similar benefits across different comorbidity phenotypes (Pint = 0.097).

CONCLUSION

3 heterogeneous comorbidity-based phenotype clusters were identified in patients with early-onset AF, associated with different treatment and prognosis. Full ABC pathway adherence improved prognosis in younger patients with AF, regardless of their comorbidity phenotypes.