Multimorbidity Status Worsening and Clinical Outcomes of Patients With Atrial Fibrillation

Comorbidities are associated with adverse outcomes in patients with atrial fibrillation (AF).

The authors aimed to assess the impact of changes in multimorbidity status on clinical outcomes and the impact of Atrial Fibrillation Better Care (ABC) adherence of patients with AF.

In the prospective nationwide COOL-AF registry, patients with nonvalvular AF were enrolled and followed up every 6 months until 3 years. Multimorbidity status was assessed at baseline and every 6 months. The composite outcomes were death, heart failure, major bleeding, and ischemic stroke/systemic embolism. Multimorbidity worsening was defined as an increase in multimorbidity group at 1 year.

A total of 3,096 patients were studied (mean age: 67.6 ± 11.1 years; 41.8% female). Four patient groups were derived from 3,096 patients as follows: low (0-1), n = 833 (26.9%); moderate (2), n = 779 (25.2%); high (3), n = 653 (21.1%); and very high comorbidities (≥4), n = 831 (26.8%). The median duration of follow-up was 24.3 months (IQR: 23.4-24.8 months; mean: 23.0 ± 4.4 months). Patients with multimorbidity worsening had an increased risk of composite outcomes (adjusted HR: 1.39; 1.13-1.71), compared to patients with no change in multimorbidity status). Patients with ABC pathway compliance were associated with a lower risk of the composite outcome, both in patients with multimorbidity worsening (HR: 0.49; 95% CI: 0.32-0.75) and "no change" groups (HR: 0.56; 95% CI: 0.45-0.70).

Patients with multimorbidity worsening had an increased risk of adverse outcomes, which were mitigated by ABC pathway compliance.