BACKGROUND
Patients with atrial fibrillation (AF) who are at increased risk of both thrombotic and haemorrhagic events represent a heterogeneous and broad clinical entity, characterized by the presence of several Janus-faced risk factors. We aimed to identify clinical phenotypes and assess the association of ABC pathway adherence with one-year outcomes in patients with AF at high risk of both stroke and bleeding.
METHODS
AF patients who had HAS-BLED score ≥3 and CHA2DS2-VASc score ≥2 were included. Hierarchical clustering was applied to identify phenotypic subgroups. We assessed the impact on net adverse clinical event (NACE) of adherence to the integrated care based on the Atrial fibrillation Better Care (ABC) pathway.
RESULTS
A total of 2,535 patients (mean age 75.4 ± 7.8 years; 58.3% male) were enrolled. Cluster I had the highest rates of prior thromboembolic and haemorrhagic events with the lowest comorbidity burden; Cluster II comprised the oldest patients with the highest prevalence of dyslipidaemia, heart failure, and peripheral artery disease; Cluster III was the youngest with the highest BMI and alcohol use. Cluster II (aOR 1.93, 95% CI 1.37-2.78), and Cluster III (aOR 1.65, 95% CI 1.10-2.50) were associated with a higher risk of all-cause death compared to Cluster I. Among patients with available ABC pathway data, adherence was associated with lower odds of 1-year MACE (OR 0.39, 95% CI 0.15-0.82).
CONCLUSION
Three distinct phenotypic clusters were identified, each with heterogeneous clinical characteristics and outcomes, underscoring the need for more individualised, phenotype-informed management strategies in this complex patient population.
A. Askarinejad, T. Bucci, Enrico Tartaglia et al.· European journal of internal...· 0 citations
AIMS
Left ventricular non-compaction (LVNC) is a genetic cardiomyopathy with presentations ranging from asymptomatic disease to heart failure, stroke, and sudden cardiac death. LVNC-related structural and functional abnormalities may increase atrial fibrillation (AF) risk, but data are limited. We assessed AF incidence in LVNC and compared outcomes in patients with versus without AF.
METHODS AND RESULTS
Two cohorts of patients were identified using the TriNetX platform: (i) patients with LVNC without a prior history of AF or stroke; and (ii) patients with LVNC and AF without a prior history of stroke. The primary objective was to assess the 3-year risk of a composite of all-cause mortality, stroke, acute myocardial infarction, and heart failure in the two cohorts. Hazard ratios (HRs) were derived from univariable cox proportional models before and after propensity score matching (PSM). Matching was conducted using a greedy nearest-neighbour approach with a caliper of 0.1.Patients with LVNC and AF (N=29,356) were older and exhibited a higher burden of comorbidities compared with LVNC patients without AF (N=39,339). In this observational analysis, after PSM, AF in patients with LVNC was associated with higher risks of stroke (HR 1.466, 95% CI 1.359-1.581), new-onset heart failure (HR 1.439, 95% CI 1.358-1.526), all-cause death (HR 1.255, 95% CI 1.200-1.312), and the composite outcome (HR 1.301, 95% CI 1.269-1.334) compared with LVNC patients without AF. The 1-year incidence of AF in patients with LVNC was 36 per 1000 person-years.
CONCLUSION
In this observational cohort, LVNC was associated with a high incidence of AF, and the presence of AF was associated with higher risks of stroke, heart failure, and all-cause death. Further prospective studies are warranted to assess the prognostic impact of AF in patients with LVNC.
A. Askarinejad, Thomas F. Lüscher, G. Y. Lip· Cardiovascular Research· 1 citation
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