Key result
Presence of ≥2 features of clinical complexity in patients with atrial fibrillation was associated with a significantly higher risk of net clinical outcomes (HR 2.08) compared to those without complexity features.
Why the study?
There is increasing concern regarding the impact of clinical complexity in patients with AF.
Does the presence of clinical complexity features increase the risk of adverse clinical outcomes in European patients with atrial fibrillation?
Observational (n=10,169)
Yes
Does the presence of clinical complexity features increase the risk of adverse clinical outcomes in European patients with atrial fibrillation?
Clinical complexity features, such as frailty, chronic kidney disease, and history of bleeding, are associated with lower oral anticoagulant use and a higher risk of adverse outcomes in patients with atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Clinical complexity features may identify higher-risk AF patients; leaves open whether targeted strategies improve outcomes.
There is increasing concern regarding impact of clinical complexity in patients with atrial fibrillation (AF). We explored the impact of different clinical complexity features in AF patients. We analyzed patients from a prospective, observational, multicenter Europe-wide AF registry. Features of clinical complexity among patients with CHA2DS2-VASc ≥2 were: (1) history of bleeding; (2) frailty; (3) chronic kidney disease (CKD); (4) ≥2 features. A total of 10,169 patients were analyzed. Of these, 141 (1.4%) had history of bleeding, 954 (9.4%) were frail, 1767 (17.4%) had CKD and 1253 (12.3%) had ≥2 features. All features of clinical complexity were less treated with OAC. History of bleeding (HR 1.94, 95% CI 1.32-2.85), frailty (HR 1.38, 95% CI 1.11-1.71), CKD (HR 1.50, 95% 1.28-1.75) and ≥2 features (HR 2.08, 95% CI 1.73-2.51) were associated with outcomes. Presence of features of clinical complexity is associated with lower use of OAC and higher risk of outcomes.
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Proietti et al. (2023) conducted an observational in Atrial Fibrillation (n=10,169). ≥2 features of clinical complexity (history of bleeding, frailty, chronic kidney disease) vs. CHA2DS2-VASc ≥2 without features of clinical complexity was evaluated on Net clinical outcome (NCO) composed of all-cause death, major adverse cardiovascular events (MACEs), and major bleeding (HR 2.08, 95% CI 1.73-2.51, p=<0.001). Presence of ≥2 features of clinical complexity in patients with atrial fibrillation was associated with a significantly higher risk of net clinical outcomes (HR 2.08) compared to those without complexity features.
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