Adverse Events and ABC Pathway Adherence Across AF Clinical Phenotypes: APHRS-AF Registry Cluster Analysis Study.

BACKGROUND

Limited studies have reported clinical phenotypes and outcome risk among Asian patients with atrial fibrillation (AF), particularly according to ABC (Atrial fibrillation Better Care) pathway adherence.

OBJECTIVES

The authors aim to identify AF clinical phenotypes and assess phenotype-specific adverse event risk and the association between ABC pathway adherence and outcomes.

METHODS

Using the Asia Pacific Heart Rhythm Society AF Registry, hierarchical cluster analysis was performed using age, sex, chronic obstructive pulmonary disease, chronic kidney disease, cancer, dyslipidemia, heart failure, hypertension, dementia, prior stroke, diabetes, coronary artery disease, and severe obesity. The primary outcome was all-cause death or major adverse cardiovascular events, including cardiovascular death, thromboembolism, acute coronary syndrome, or heart failure.

RESULTS

Among 3,468 patients (mean age: 68.3 ± 11.9 years; 1,151/3,468 [33.2%] women), followed for a median of 364 days (IQR: 341-373), 5 clusters were identified: younger with low cardiovascular risk factors (CVRF), younger dysmetabolic, older low CVRF, older high CVRF, and older heart failure. Compared with younger low-CVRF patients, primary outcome risk was higher in older low-CVRF (HR: 2.70, 95% CI: 1.49-4.90), older high-CVRF (HR: 3.33, 95% CI: 1.95-5.69), and older heart failure patients (HR: 4.15, 95% CI: 2.29-7.54), but not in younger dysmetabolic patients (HR: 1.36, 95% CI: 0.67-2.75). ABC adherence was associated with lower primary outcome risk (HR: 0.53, 95% CI: 0.38-0.74), without significant interaction across phenotypes.

CONCLUSIONS

Five clinical phenotypes with distinct adverse event risks were identified in Asian patients with AF. The ABC pathway adherence consistently mitigated adverse event risk across different phenotypes.

REGISTRATION: ClinicalTrials.gov (Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia [AF-Registry]; NCT04807049).