Heart rhythm · 2025
Association of comorbidity patterns with outcomes and relation with the ABC pathway effectiveness in European patients with atrial fibrillation.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Romiti Giulio Francesco, Corica Bernadette, Mei Davide Antonio, Vitolo Marco, Bucci Tommaso, Bisson Arnaud, Fauchier Laurent, Boriani Giuseppe, Proietti Marco, Lip Gregory Y H
Аннотация
BACKGROUND: Patients with atrial fibrillation (AF) show increasingly complex comorbidity profiles, with detrimental effects on prognosis.
OBJECTIVE: The purpose of this study was to explore patterns of comorbidities in patients with AF.
METHODS: From a European-wide prospective observational registry of AF patients, we performed a latent class analysis to identify patterns of comorbidities. We analyzed association with use of oral anticoagulant (OAC) and with clinical outcomes at 2 years. Primary outcome was a composite of all-cause mortality and major adverse cardiovascular events. Association of the Atrial fibrillation Better Care (ABC) pathway on the risk of primary outcome across groups was also assessed.
RESULTS: A total of 9613 AF patients were included (mean age 68.9 ± 11.4 years, 40.2% female). We identified 5 comorbidity patterns, with increasing clinical complexity phenotypes: low morbidity (46.1%), cardiovascular (25.0%), metabolic (11.3%), "heart failure" (9.7%), and multisystemic pattern (8.0%). OACs were less used in the "heart failure" and multisystemic patterns (odd ratio [OR] 0.69, 95% confidence interval [CI] 0.53-0.90; and OR 0.36, 95% CI 0.26-0.50, respectively), and more used in the metabolic pattern (OR 1.41, 95% CI 1.06-1.86). Compared with the low-morbidity phenotype, all other patterns except for the metabolic pattern were associated with hazard of the primary outcome, with highest magnitude observed for the "heart failure" (hazard ratio [HR] 2.18, 95% CI 1.74-2.72) and multisystemic patterns (HR 2.14, 95% CI 1.62-2.82). Adherence to the ABC pathway was similarly associated with reduced hazard of the primary outcome across all groups (P for interaction = .885).
CONCLUSION: Comorbidities patterns are heterogeneously associated with treatment and prognosis in AF patients. Adherence to the ABC integrated pathway showed similar association with outcomes across all comorbidity patterns.
OBJECTIVE: The purpose of this study was to explore patterns of comorbidities in patients with AF.
METHODS: From a European-wide prospective observational registry of AF patients, we performed a latent class analysis to identify patterns of comorbidities. We analyzed association with use of oral anticoagulant (OAC) and with clinical outcomes at 2 years. Primary outcome was a composite of all-cause mortality and major adverse cardiovascular events. Association of the Atrial fibrillation Better Care (ABC) pathway on the risk of primary outcome across groups was also assessed.
RESULTS: A total of 9613 AF patients were included (mean age 68.9 ± 11.4 years, 40.2% female). We identified 5 comorbidity patterns, with increasing clinical complexity phenotypes: low morbidity (46.1%), cardiovascular (25.0%), metabolic (11.3%), "heart failure" (9.7%), and multisystemic pattern (8.0%). OACs were less used in the "heart failure" and multisystemic patterns (odd ratio [OR] 0.69, 95% confidence interval [CI] 0.53-0.90; and OR 0.36, 95% CI 0.26-0.50, respectively), and more used in the metabolic pattern (OR 1.41, 95% CI 1.06-1.86). Compared with the low-morbidity phenotype, all other patterns except for the metabolic pattern were associated with hazard of the primary outcome, with highest magnitude observed for the "heart failure" (hazard ratio [HR] 2.18, 95% CI 1.74-2.72) and multisystemic patterns (HR 2.14, 95% CI 1.62-2.82). Adherence to the ABC pathway was similarly associated with reduced hazard of the primary outcome across all groups (P for interaction = .885).
CONCLUSION: Comorbidities patterns are heterogeneously associated with treatment and prognosis in AF patients. Adherence to the ABC integrated pathway showed similar association with outcomes across all comorbidity patterns.