Association of cardiac and non-cardiac comorbidities with adverse outcomes of atrial fibrillation

1. A cluster analysis of European atrial fibrillation (AF) patients found that both cardiac and non-cardiac comorbidities were associated with a greater risk of adverse outcomes.

Evidence Rating Level: 2 (Good)

Atrial Fibrillation (AF) is a multifactorial condition associated with numerous risk factors and co-morbidities. These include cardiovascular (CV) comorbidities, such as heart failure, stroke, and coronary artery disease, as well as non-CV conditions, such as diabetes mellitus and chronic kidney disease. Due to the multitude of clinical phenotypes associated with AF, cluster analysis can be used to identify which phenotypes are at greater risk of adverse outcomes and mortality. This data analytics technique has been used in studying other CV conditions, but has seldom been applied to study AF. The current study is the largest observational non-industry of AF patients in Europe, known as the EORP-AF: Their aim involved identifying relevant multi-morbidity clinical phenotypes of AF, along with evaluating differences in clinical management, use of resources, and adverse outcomes. From the 9363 patients included in the analysis, three clusters were identified: Cluster 1 consisted of older patients with non-CV comorbidities (median [IQR] age of 73 [65-78] years), younger patients with few comorbidities (median [IQR] age 65 [56-72] years), and older patients with high prevalence of CV comorbidities and risk factors (median [IQR] age 73 [66-78] years). The study found that in terms of AF management, Cluster 3 had the highest use of antiplatelet drugs (p < 0.001), and oral anticoagulants (OACs) were lowest in Cluster 2 (p < 0.001). As well, a rate control strategy was more common in Cluster 2, whereas a rhythm control strategy was more common in Cluster 2 (p < 0.001). Within the mean [SD] length of hospital stay was lowest in Cluster 2 (4.36 [6.33] days), followed by Cluster 1 (6.52 [7.29] days), with the highest in Cluster 3 (8.07 [8.50] days), with differences between each cluster being significant (p < 0.001). In terms of adverse outcomes, such as CV events, all-cause death, and a composite score of the two, the lowest rate of events was found in Cluster 2, followed by Cluster 1 and 3 respectively. Compared to Cluster 2, the hazards ratio for the composite score was 2.09 in Cluster 1 (95% CI 1.74-2.51) and 2.79 in Cluster 3 (95% CI 2.32-3.35). Overall, this study demonstrated that the presence of comorbidities in older AF patients, whether CV or non-CV, were associated with a greater risk of adverse outcomes, compared to younger patients with few comorbidities. 

Click to read the study in BMC Medicine

Image: PD

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