Cardiovascular-kidney-metabolic syndrome and atrial fibrillation: insights from two real-world prospective registries across europe and east asia

Patients with atrial fibrillation (AF) commonly present with other comorbidities, including metabolic, kidney, or cardiovascular risk factors, which have a complex interplay leading to increased mortality and morbidity.

AF patients with available data for CKM staging were included from the EORP-AF and APHRS registries. Patients were stratified into three CKM risk categories based on CKM stage: (i) low CKM risk (CKM stage 2), (ii) moderate CKM risk (CKM stage 3), (iii) high CKM risk (CKM stage 4). Univariate and multivariable Cox regression analysis were performed to assess the associations between CKM risk status and the adverse outcomes including composite outcome (all-cause mortality and major adverse cardiovascular events (MACE)), all-cause mortality, MACE, thromboembolic events, and any major bleeding.

Total of 5577 patients (age 71.5, SD 10.3; 59.0% male) were enrolled: of these, low, moderate, and high CKM risk groups were present in 1090 (19.5%), 159 (2.9%), and 4328 (77.6%) patients, respectively. Compared to the low CKM risk group, patients in high risk group had significantly higher risk of composite outcome (aHR 1.93; 95% CI 1.58-2.36), all-cause death (aHR 1.90; 95% CI 1.48-2.45), and MACE (aHR 2.28; 95% CI 1.73-3.00). Compared to the patients with moderate CKM risk, the high risk CKM patients experienced higher hazards of MACE (aHR 3.49 95% CI 1.44-8.42)

High CKM risk was associated with an increased risk of all-cause death and MACE. A holistic or integrated care approach management strategy is recommended to improve clinical outcomes in these patients.Table 1Table 2