Clinical complexity in patients with atrial fibrillation: exploring differential risk profiles from European and Asian cohorts
Year: 2025
Type: article
Abstract: AIMS: Clinical complexity (CC) in atrial fibrillation (AF) reflects overlapping risk factors that raise vulnerability to both thromboembolism and bleeding. Ethnic differences in the expression of CC remain poorly characterized. METHODS AND RESULTS: We performed a post hoc analysis of the EORP-AF and APHRS-AF registries. CC was defined as a CHA₂DS₂-VASc score ≥2 plus ≥1 of: (i) age ≥75 and BMI <23 kg/m², (ii) chronic kidney disease, or (iii) prior major bleeding. Multivariable logistic regression identified predictors of CC, oral anticoagulant (OAC) use, and rhythm control. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndromes, and thromboembolic events. Secondary outcomes included each individual component and major bleeding. Associations were assessed using Cox regression models. Among 14 055 patients, 2794 (19.9%) met CC criteria (mean age 77 ± 9 years; 46% female). Compared to Europeans, Asian patients with CC had a distinct clinical profile and were less likely to receive OAC (OR 0.75, 95% CI 0.57-1.01) or rhythm control (OR 0.53, 95% CI 0.41-0.69). CC was independently associated with increased risk of composite outcome (HR 1.55, 95% CI 1.35-1.77), all-cause death (HR 1.65, 95% CI 1.42-1.93), MACE (HR 1.50, 95% CI 1.26-1.80), cardiovascular death (HR 1.81, 95% CI 1.40-2.36), and major bleeding (HR 2.02, 95% CI 1.47-2.77). The excess risk of the composite outcome was greater in Asians (HR 2.28, 95% CI 1.57-3.32) than in Europeans (HR 1.51, 95% CI 1.31-1.75; P-interaction = 0.036). CONCLUSION: Among AF patients with CC, those enrolled in Asia exhibited marked differences in clinical profiles, management strategies, and outcomes, suggesting greater vulnerability to CC in the Asian population.
Source: EP Europace
Institutions: University of Liverpool, University of Perugia, Liverpool Heart and Chest Hospital, Liverpool John Moores University, University of L'Aquila, San Salvatore Hospital, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Iran University of Medical Sciences, Sapienza University of Rome, University of Hong Kong, National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, Medical University of Białystok, Aalborg University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,909
OpenAlex ID: W4414379649