Association of comorbidity patterns with outcomes and relation with the ABC pathway effectiveness in European patients with Atrial Fibrillation

Background: Patients with Atrial Fibrillation (AF) show increasingly complex comorbidity profiles, with detrimental effects on prognosis. Objective: To explore patterns of comorbidities in patients with AF. Methods: From a European-wide prospective observational registry of AF patients, we performed a latent class analysis to identify patterns of comorbidities. We analysed association with use of oral anticoagulant (OAC), and with clinical outcomes at 2 years. Primary outcome was a composite of all-cause mortality and major adverse cardiovascular events. Association of ABC pathway on the risk of primary outcome across groups was also assessed. Results: 9,613 AF patients were included (mean age 68.9±11.4 years, 40.2% females). We identified 5 comorbidity patterns, with increasing clinical complexity phenotypes: low morbidity (46.1%), cardiovascular (25.0%), metabolic (11.3%), 'heart failure' (9.7%) and multisystemic pattern (8.0%). OACs were less used in the 'heart failure' and multisystemic patterns (OR [95%CI]: 0.69 [0.53-0.90] and 0.36 [0.26-0.50], respectively), and more used in the metabolic pattern (OR [95%CI]: 1.41 [1.06-1.86]). Compared with the low morbidity phenotype, all other patterns except for the metabolic pattern were associated with hazard of the primary outcome, with highest magnitude observed for the 'heart failure' (HR [95%CI]: 2.18 [1.74-2.72]) and the multisystemic patterns (HR [95%CI]: 2.14 [1.62-2.82]). Adherence to the ABC pathway was similarly associated reduced hazard of the primary outcome across all groups (p for interaction=0.885). Conclusion: Comorbidities patterns are heterogeneously associated with treatment and prognosis in AF patients. Adherence to the ABC integrated pathway has similar association with outcomes across all comorbidity patterns.