Cardiovascular-kidney-metabolic domains and impact on antithrombotic treatment, integrated care and clinical outcomes in patients with atrial fibrillation: results from a prospective European registry.

Abstract

Cardiovascular, kidney, and metabolic (CKM) conditions frequently coexist with atrial fibrillation (AF), but their impact in AF population remains poorly characterized. To evaluate the prevalence, clinical impact of CKM domains and the effect of integrated care on outcomes in a European cohort of patients with AF. In the EORP-AF General Long-Term Registry, we define CKM domains according to cardiovascular, kidney and metabolic conditions. Patients were stratified by the number and combinations of CKM domains. The primary outcome was a composite of all-cause death, acute coronary syndrome, and thromboembolic events. The impact of adherence to the Atrial fibrillation Better Care (ABC) integrated care pathway was assessed. Among 7,736 individuals included in the analysis (39.8 % women; mean age 68.1 [SD 11.6] years), CKM domains were highly prevalent (93.7 % had ≥1 domain; 21.4 % had all three), with regional variation. A higher burden of CKM domains was associated with increased risk of primary outcome events (hazard ratio [HR] [95 % confidence interval] 1 vs 0 domains: HR 1.45 [0.93-2.26]; 2 vs 0: HR 2.05 [1.32-3.19]; 3 vs 0: HR 2.69 [1.71-4.23]). Groups including the cardiovascular domain, especially cardio-kidney, had the highest hazard of events (HR 4.00 [2.41-6.65]). ABC pathway adherence was associated with lower risk of events consistently across number (Pint = 0. 585) and group (Pint = 0.063) of CKM domains. In this large cohort of European AF patients, CKM domains were highly prevalent and associated with progressively worse outcomes. ABC-integrated care was associated with favourable outcomes across CKM profiles.