Physical activity and risk of adverse events in atrial fibrillation: evidence from European and Asian cohorts

To evaluate differences in clinical characteristics and outcomes based on physical activity levels in patients with atrial fibrillation (AF), comparing Europeans and Asians.

Post-hoc analysis of two prospective registries from Europe and the Asia-Pacific. Patients were classified as inactive (no exercise or <3 h/week) or active (≥3 h/week). The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE). Secondary outcomes included all-cause death, MACE, major bleeding, individual MACE components. Cox model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes. Subgroup analyses were performed by clinically relevant variables and enrolment setting. Of 13 126 participants (69 ± 12 years; 39% female), 3639 (28%) were physically active and 9487 (72%) physically inactive. Across both groups, Asians had lower odds of obesity, symptomatic AF and heart failure, but higher odds of cardiovascular risk factors than Europeans. After a median follow-up of 514 days, physically active AF patients had a lower risk of composite outcome (HR 0.66, 95%CI 0.56–0.78), all-cause death (HR 0.52, 95%CI 0.42–0.65), MACE (HR 0.80, 95%CI 0.65–0.99), cardiovascular death (HR 0.60, 95%CI 0.42–0.86), with no significant differences between Europeans and Asians (p_interaction for composite outcome = 0.298). The risk of the composite outcome decreased progressively with increasing levels of physical activity, with no significant differences between Europeans and Asians (p_interaction = 0.845).

In patients with AF, self-reported physical activity is associated with a lower risk of adverse events, consistently across Europe and Asia. Physical activity may represent a component of a lower-risk clinical profile in AF.