Giulio Francesco Romiti, Bernadette Corica, Davide Antonio Mei, Marco Vitolo, Tommaso Bucci, Arnaud Bisson, Laurent Fauchier, Giuseppe Boriani, Marco Proietti, Gregory Y H Lip
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引用次数: 0
Abstract
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.
期刊介绍：
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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