Liver disease in management and outcomes of European and Asian patients with atrial fibrillation: A report from two observational prospective registries
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background In patients with atrial fibrillation (AF), the impact of liver disease (LD) on oral anticoagulant (OAC) prescription and outcomes remains unclear, as well as possible differences between European and Asian populations. Aim To examine the impact of LD on OAC prescriptions and risks of adverse outcomes in a large cohort of European and Asian AF patients. Methods AF patients were derived from two large observational registries held in Europe and Asia. OAC prescription and risk of outcomes were analysed according to LD at baseline. The primary outcome was the composite of all‐cause death and major adverse cardiovascular events (MACEs). Logistic regression assessed associations with OAC prescription, and Cox regression analyses evaluated risks of outcomes. Interaction analyses were performed between European and Asian patients. Results Among 15,681 patients (mean age 68.4 ± 10.7 years; 37.1% female), 517 (3.3%) had LD. The OAC prescription rate was similar among European and Asian individuals (6.8% vs. 82.9%, p = .113). After adjustments, LD was associated with lower OAC prescription (OR .67, 95% CI .53–.84), with a greater reduction in European than in Asian patients ( p int = .015). LD was associated with a higher risk of the composite outcome (HR 1.42, 95% CI 1.11–1.81) and MACEs (HR 1.47, 95% CI 1.07–2.02), with no significant European versus Asian differences ( p int = .631). Among LD patients, those not prescribed OAC had a higher MACE risk compared with those prescribed OAC ( p int = .050), with no differences in major bleeding. Conclusions In AF, LD is associated with reduced OAC prescription, especially in Europe, and a higher risk of adverse outcomes, particularly in patients not receiving OAC, with no significant differences between European and Asian cohorts.
DOI: 10.1111/eci.70193
Institutions: University of Modena and Reggio Emilia, University of Liverpool, Liverpool Heart and Chest Hospital, Azienda Ospedaliero-Universitaria di Modena, Liverpool John Moores University, Sapienza University of Rome, Queen Mary Hospital, University of Hong Kong, National Yang Ming Chiao Tung University, Taipei Veterans General Hospital, University of Milan, Istituti Clinici Scientifici Maugeri, 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: $4,100
OpenAlex ID: W7140895672