Impact of cardiovascular-kidney-metabolic conditions on clinical outcomes in patients with atrial fibrillation: results from a prospective cohort

INTRODUCTION: Cardiovascular‑kidney‑metabolic (CKM) conditions are frequently encountered in clinical practice. OBJECTIVES: Our aim was to evaluate the epidemiology and impact of CKM conditions in patients with atrial fibrillation (AF), with a focus on their association with left atrial (LA) remodeling and clinical outcomes. PATIENTS AND METHODS: Patients with AF enrolled in this single‑center prospective study were stratified based on the presence of CKM comorbidities. We assessed the relationship between CKM status, LA remodeling, and adverse clinical outcomes. The primary outcome was a composite of all‑cause death, acute coronary syndrome, ischemic stroke and transient ischemic attack, and hospitalization for heart failure. RESULTS: A total of 1236 patients at a median (interquartile range) age of 75 (66-82) years (37.5% women) were included. Among them, 43.4% had no CKM conditions, 34.6% had 1 CKM condition, 16.7% had 2 CKM conditions, and 5.3% had 3 CKM conditions. LA remodeling was progressively more pronounced with increasing CKM burden. After median follow‑up of 524 (217-1297) days, 283 events of the primary outcome (27.5%) were reported. As compared with the patients with 0 CKM conditions, there was a progressively higher risk of adverse events in the patients with 1 CKM condition (adjusted hazard ratio [aHR], 1.56; 95% CI, 1.14-2.12), 2 CKM conditions (aHR, 1.98; 95% CI, 1.4-2.79), and 3 CKM conditions (aHR, 2.55; 95% CI, 1.61-4.02). The impact of the CKM status was consistent irrespective of sex, obesity, and AF type. CONCLUSIONS: CKM multimorbidity is highly prevalent in AF patients, where it is associated with progressive LA remodeling and a stepwise increase in the risk of adverse events.