Cardio-kidney-metabolic phenotypes predicted all-cause mortality (aHR 1.97; 95% CI 1.89-2.06; P<0.001) and major adverse kidney events in patients with atrial fibrillation.
Cohort (n=48,810)
Do cardio-kidney-metabolic (CKM) phenotypes predict adverse clinical outcomes in adults with atrial fibrillation?
Cardio-kidney-metabolic phenotypes, particularly kidney involvement and obesity, effectively stratify the risk of mortality, renal events, and heart failure hospitalizations in patients with atrial fibrillation.
Hazard Ratio: 1.97 (95% CI 1.89–2.06)
p-value: p=<0.001
BACKGROUND: The prognostic impact of distinct cardio-kidney-metabolic (CKM) phenotypes on outcomes in atrial fibrillation (AF) remains unclear. OBJECTIVES: The study sought to characterize CKM phenotypes and burden in AF and evaluate associations with clinical outcomes, exploring body mass index (BMI)-related heterogeneity. METHODS: This retrospective cohort study included 48,810 adults with AF (2014-2022). Patients were classified by CKM burden and phenotypes. Multivariable Cox and Fine-Gray models were used for heart failure hospitalization (HHF), transient ischemic attack/ischemic stroke, major adverse kidney events (MAKE), major adverse cardiovascular events (MACE), and all-cause mortality. RESULTS: ) predicted all-cause mortality (aHR: 1.97; 95% CI: 1.89-2.06; P < 0.001) and MAKE (aHR: 1.77; 95% CI: 1.70-1.84; P < 0.001), whereas obesity increased HHF risk (sHR: 1.42; 95% CI: 1.29-1.56; P < 0.001). CONCLUSIONS: CKM phenotypes stratify multisystem risks in AF. Kidney domain involvement identifies patients at highest risk for mortality and MAKE, while metabolic phenotypes are strongly associated with HHF. BMI further differentiates risk, with underweight status driving mortality and renal adverse events.
Hsu et al. (2026) conducted a cohort in atrial fibrillation (n=48,810). Cardio-kidney-metabolic (CKM) phenotypes was evaluated on all-cause mortality (aHR 1.97, 95% CI 1.89-2.06, p=<0.001). Cardio-kidney-metabolic phenotypes predicted all-cause mortality (aHR 1.97; 95% CI 1.89-2.06; P<0.001) and major adverse kidney events in patients with atrial fibrillation.