Clinical Outcomes According to Age and Atrial Fibrillation Type: Insights from the Multicentre REGUEIFA Registry

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=997). Intervention: Age ≥90 years vs. Age <75 years. Primary outcome: Composite of all-cause mortality, ischaemic stroke, or worsening heart failure (HR 6.50, 95% CI 3.60-11.72, p=<0.001).

Q: What does this research mean for the field?

In patients with atrial fibrillation, advancing age is the primary independent predictor of adverse clinical outcomes—with age ≥90 conferring a 6.5-fold higher risk of death, stroke, or heart failure worsening compared to age <75—whereas AF type loses prognostic significance after multivariable adjustment. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Alejandro Manuel López-Pena; Juliana Elices‐Teja; Ö. Duran; Laila González Melchor; María Vázquez Caamaño; E. Fernández-Obanza Windscheid; Eva González‐Babarro; Pilar Cabanas‐Grandío; Miriam Piñeiro‐Portela; Óscar Prada‐Delgado; Mario Gutiérrez Feijoo; Evaristo Freire; Óscar Dı́az-Castro; Javier Muñiz; Eduardo Barge‐Caballero; Javier García‐Seara; Carlos González‐Juanatey

doi:10.3390/jcm15187295

September 19, 2026Journal of Clinical MedicineOpen Access

Clinical Outcomes According to Age and Atrial Fibrillation Type: Insights from the Multicentre REGUEIFA Registry

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Why the study?

The relative prognostic impact of age compared with atrial fibrillation type on clinical outcomes remains uncertain in patients with AF.

Does advancing age or atrial fibrillation type independently predict adverse clinical outcomes in a real-world atrial fibrillation cohort?

Key Points

To assess the prognostic association between age, atrial fibrillation (AF) type, and clinical outcomes in a real-world cohort of patients with AF.
Prospective, observational, multicentre cohort study analyzing data from the REGUEIFA registry across eight hospitals in northwestern Spain.
Included 997 consecutive patients with AF stratified into four age groups (<75, 75–84, 85–89, and ≥90 years) and followed for at least 2 years.
Outcomes assessed were all-cause mortality, heart failure worsening, ischaemic stroke, and a composite endpoint, evaluated with multivariable Cox regression models.
The risk of the composite endpoint increased stepwise across age groups compared with patients <75 years: HR 2.01 (95% CI 1.47–2.76; p < 0.001) for 75–84 years, HR 2.34 (95% CI 1.41–3.90; p = 0.001) for 85–89 years, and HR 6.50 (95% CI 3.60–11.72; p < 0.001) for ≥90 years.
Each additional year of age was associated with a 9% higher mortality risk (HR 1.09; 95% CI 1.06–1.13; p < 0.001), whereas AF type was not independently associated with any analyzed clinical outcomes after multivariable adjustment.
A rhythm-control strategy was independently associated with a lower risk of the composite endpoint (HR 0.50; 95% CI 0.34–0.74; p = 0.001) and worsening heart failure (HR 0.47; 95% CI 0.30–0.74; p = 0.001).

Study Design

Type

Cohort (n=997)

Multicenter

Yes

Structured PICO

Does advancing age or atrial fibrillation type independently predict adverse clinical outcomes in a real-world atrial fibrillation cohort?

P

Population

997 adults with atrial fibrillation from a Spanish multicenter registry, followed for at least 2 years to evaluate the prognostic value of age versus AF type.

E

Exposure

Advancing age (including stratification up to ≥90 years) and atrial fibrillation type (first-diagnosed, paroxysmal, persistent, long-standing persistent/permanent)

C

Comparator

Younger age strata (<75 years) and paroxysmal or first-diagnosed atrial fibrillation

O

Outcome

Composite endpoint comprising all-cause mortality, worsening heart failure, and ischaemic strokecomposite

Main Result

Hazard Ratio: 6.5 (95% CI 3.6–11.72)

Absolute Event Rate: 73.7% vs 14.8%

p-value: p=<0.001

Limitations

Observational design precludes inference of causality
Residual confounding cannot be excluded despite multivariable adjustment
AF type was classified at baseline and may change over time
No systematic assessment of AF burden was available
Treatment strategies differed substantially across age groups
Observational design limits causal inferences
Potential for residual confounding
AF type assessed only at baseline
Lack of systematic AF burden assessment
Differences in rhythm-control interventions across age groups

Implication

Patient age and cumulative clinical comorbidities are far stronger prognostic drivers in atrial fibrillation than the specific subtype or temporal pattern of the arrhythmia.

Abstract

Background/Objectives: Atrial fibrillation (AF) represents the most common sustained cardiac arrhythmia, and its incidence rises markedly with advancing age. The relative prognostic impact of age compared with AF type remains uncertain. This study assessed the association between age, AF type, and clinical outcomes in a large real-world AF cohort. Methods: This study was based on data from the prospective, observational, multicentre REGUEIFA registry, which includes consecutive patients with AF treated at eight hospitals in northwestern Spain. Patients were stratified by age and AF type. Baseline characteristics, comorbidities, treatments, and risk scores were collected. Patients were followed for at least 2 years, and outcomes included all-cause mortality, heart failure (HF) worsening, stroke, and a composite endpoint. Results: A total of 997 patients were included. Increasing age was associated with a worse clinical profile, with higher comorbidity burden and increased thromboembolic and bleeding risk. During follow-up, adverse events increased stepwise with age, including mortality, HF worsening, and the composite endpoint. AF type was not independently associated with outcomes after multivariable adjustment. Rhythm-control strategy was independently associated with a lower risk of the composite endpoint. Age remained an independent predictor of all outcomes. Risk of the composite endpoint increased across age groups (HR 2.01 for 75–84 years; 2.34 for 85–89 years; 6.50 for ≥90 years vs. <75 years). Each additional year of age was associated with a 9% higher mortality risk (HR 1.09; 95% CI 1.06–1.13). Conclusions: In this prospective real-world cohort of patients with AF, age was the strongest and most consistent predictor of adverse clinical outcomes, whereas AF type lost prognostic significance after adjustment. These findings support age and overall clinical burden as key determinants of prognosis, favouring a patient-centred approach over AF subtype classification.

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Cite This Study

López-Pena et al. (2026) conducted a cohort in Atrial fibrillation (n=997). Age ≥90 years vs. Age <75 years was evaluated on Composite of all-cause mortality, ischaemic stroke, or worsening heart failure (HR 6.50, 95% CI 3.60-11.72, p=<0.001).

synapsesocial.com/papers/6ad0fd553afa093ea9ad03de https://doi.org/10.3390/jcm15187295