Background: Limited studies have reported clinical phenotypes and outcome risk among Asian patients with atrial fibrillation (AF), particularly according to ABC (Atrial fibrillation Better Care) pathway adherence. Objectives: The authors aim to identify AF clinical phenotypes and assess phenotype-specific adverse event risk and the association between ABC pathway adherence and outcomes. Methods: Using the Asia Pacific Heart Rhythm Society AF Registry, hierarchical cluster analysis was performed using age, sex, chronic obstructive pulmonary disease, chronic kidney disease, cancer, dyslipidemia, heart failure, hypertension, dementia, prior stroke, diabetes, coronary artery disease, and severe obesity. The primary outcome was all-cause death or major adverse cardiovascular events, including cardiovascular death, thromboembolism, acute coronary syndrome, or heart failure. Results: Among 3,468 patients (mean age: 68.3 ± 11.9 years; 1,151/3,468 [33.2%] women), followed for a median of 364 days (IQR: 341-373), 5 clusters were identified: younger with low cardiovascular risk factors (CVRF), younger dysmetabolic, older low CVRF, older high CVRF, and older heart failure. Compared with younger low-CVRF patients, primary outcome risk was higher in older low-CVRF (HR: 2.70, 95% CI: 1.49-4.90), older high-CVRF (HR: 3.33, 95% CI: 1.95-5.69), and older heart failure patients (HR: 4.15, 95% CI: 2.29-7.54), but not in younger dysmetabolic patients (HR: 1.36, 95% CI: 0.67-2.75). ABC adherence was associated with lower primary outcome risk (HR: 0.53, 95% CI: 0.38-0.74), without significant interaction across phenotypes. Conclusions: Five clinical phenotypes with distinct adverse event risks were identified in Asian patients with AF. The ABC pathway adherence consistently mitigated adverse event risk across different phenotypes. Registration: ClinicalTrials.gov (Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia [AF-Registry]; NCT04807049).
Adverse Events and ABC Pathway Adherence Across AF Clinical Phenotypes: APHRS-AF Registry Cluster Analysis Study / Bucci, T., Romiti, G.F., Mantovani, M., Mei, D.A., Shantsila, A., Teo, W., Park, H., Shimizu, W., Tse, H., Proietti, M., Chao, T., Lip, G.Y.H.. - In: JACC. ASIA. - ISSN 2772-3747. - (2026). [10.1016/j.jacasi.2026.06.038]
Adverse Events and ABC Pathway Adherence Across AF Clinical Phenotypes: APHRS-AF Registry Cluster Analysis Study
Bucci, Tommaso;Romiti, Giulio Francesco;
2026
Abstract
Background: Limited studies have reported clinical phenotypes and outcome risk among Asian patients with atrial fibrillation (AF), particularly according to ABC (Atrial fibrillation Better Care) pathway adherence. Objectives: The authors aim to identify AF clinical phenotypes and assess phenotype-specific adverse event risk and the association between ABC pathway adherence and outcomes. Methods: Using the Asia Pacific Heart Rhythm Society AF Registry, hierarchical cluster analysis was performed using age, sex, chronic obstructive pulmonary disease, chronic kidney disease, cancer, dyslipidemia, heart failure, hypertension, dementia, prior stroke, diabetes, coronary artery disease, and severe obesity. The primary outcome was all-cause death or major adverse cardiovascular events, including cardiovascular death, thromboembolism, acute coronary syndrome, or heart failure. Results: Among 3,468 patients (mean age: 68.3 ± 11.9 years; 1,151/3,468 [33.2%] women), followed for a median of 364 days (IQR: 341-373), 5 clusters were identified: younger with low cardiovascular risk factors (CVRF), younger dysmetabolic, older low CVRF, older high CVRF, and older heart failure. Compared with younger low-CVRF patients, primary outcome risk was higher in older low-CVRF (HR: 2.70, 95% CI: 1.49-4.90), older high-CVRF (HR: 3.33, 95% CI: 1.95-5.69), and older heart failure patients (HR: 4.15, 95% CI: 2.29-7.54), but not in younger dysmetabolic patients (HR: 1.36, 95% CI: 0.67-2.75). ABC adherence was associated with lower primary outcome risk (HR: 0.53, 95% CI: 0.38-0.74), without significant interaction across phenotypes. Conclusions: Five clinical phenotypes with distinct adverse event risks were identified in Asian patients with AF. The ABC pathway adherence consistently mitigated adverse event risk across different phenotypes. Registration: ClinicalTrials.gov (Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia [AF-Registry]; NCT04807049).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
