Features of Clinical Complexity in European Patients with Atrial Fibrillation: A Report from a European Observational Prospective AF Registry

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, multicentre Europe-wide AF registry. Features of clinical complexity among patients with CHA2DS2-VASc ≥2 were: i) history of bleeding; ii) frailty; iii) chronic kidney disease (CKD); iv) ≥2 features. A total of 10,169 patients were analysed. Of these, 141 (1.4%) had history of bleeding, 954 (9.4%) were frail, 1,767 (17.4%) had CKD and 1,253 (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.