Cardiovascular-kidney-metabolic domains and impact on antithrombotic treatment, integrated care and clinical outcomes in patients with atrial fibrillation: results from a prospective European registry

Background: Cardiovascular, kidney, and metabolic (CKM) conditions frequently coexist with atrial fibrillation (AF), but their impact in AF population remains poorly characterized. Objective: To evaluate the prevalence, clinical impact of CKM domains and the effect of integrated care on outcomes in a European cohort of patients with AF. Methods: In the EORP-AF General Long-Term Registry, we define CKM domains according to cardiovascular, kidney and metabolic conditions. Patients were stratified by the number and combinations of CKM domains. The primary outcome was a composite of all-cause death, acute coronary syndrome, and thromboembolic events. The impact of adherence to the Atrial fibrillation Better Care (ABC) integrated care pathway was assessed. Results: Among 7,736 individuals included in the analysis (39.8 % women; mean age 68.1 [SD 11.6] years), CKM domains were highly prevalent (93.7 % had ≥1 domain; 21.4 % had all three), with regional variation. A higher burden of CKM domains was associated with increased risk of primary outcome events (hazard ratio [HR] [95 % confidence interval] 1 vs 0 domains: HR 1.45 [0.93-2.26]; 2 vs 0: HR 2.05 [1.32-3.19]; 3 vs 0: HR 2.69 [1.71-4.23]). Groups including the cardiovascular domain, especially cardio-kidney, had the highest hazard of events (HR 4.00 [2.41-6.65]). ABC pathway adherence was associated with lower risk of events consistently across number (Pint = 0. 585) and group (Pint = 0.063) of CKM domains. Conclusions: In this large cohort of European AF patients, CKM domains were highly prevalent and associated with progressively worse outcomes. ABC-integrated care was associated with favourable outcomes across CKM profiles.