Patterns of co-existing long-term conditions in atrial fibrillation among males and females: a longitudinal population-based study

Abstract Introduction Atrial fibrillation (AF) is the most common heart rhythm disorder, affecting millions of people worldwide. AF patients often experience multiple long-term conditions, with a majority presenting as multiple co-existing conditions. While the evidence of high prevalence of multiple long-term conditions (MLTCs) in this population is well documented in literature, the nature of co-occurrences and how these progress over time has not been detailed. Purpose This study aimed to identify sex- and age- specific comorbidity patterns in AF patients and determine the temporal directionality of comorbidity pairs, providing insights into the sequential development of AF multiple long-term conditions. Methods We analysed electronic health records (EHR) from 24933 patients with atrial fibrillation (AF) between 1st January 2000 and 31st December 2023. The analysis was stratified according to sex and age. Sex assigned at birth was recorded as either male or female, and age was categorised into two groups, younger than 65 years old and 65 years old and above. MLTCs were defined as two or more chronic conditions. Temporal analysis was used to identify directional pairwise associations among 23 long-term conditions. Fisher’s exact test was applied on 2 × 2 contingency tables constructed for each condition pair and the resulting p-values were corrected using Bonferroni correction for multiple testing. The temporal direction of the significant pairwise associations were identified using the Binomial test. Results The study population comprised 55.7% males and 44.3% females, with males having a mean of 6.3 ± 3.2 long-term conditions (LTCs) and females having a mean of 6.7 ± 3.5 LTCs. Approximately 92% of both sexes had multiple long-term conditions. Hypertension and lipid metabolism disorders were the most prevalent conditions in both sexes. Hypertension frequently preceded lipid metabolism disorders, sleep disorders, and chronic arthritis in both older males and females, while also showing bidirectional associations with sleep disorders in younger males and females. Younger males showed strong directional links from lipid metabolism disorders to sleep disorders and from obesity to coronary heart disease, whereas younger females had more pronounced connections to metabolic conditions like obesity and diabetes. Additionally, sleep disorders and obesity in younger individuals often co-occurred. Conclusions This study provides novel insights into the sex-specific temporal associations of MLTCs in AF patients. Our findings highlight distinct comorbidity patterns between sexes and age groups, suggesting the need for tailored approaches to risk stratification and preventive interventions in AF management.