Multimorbidity Status Worsening and Clinical Outcomes of Patients With Atrial Fibrillation

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BACKGROUND: Comorbidities are associated with adverse outcomes in patients with atrial fibrillation (AF). OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Patients with multimorbidity worsening had an increased risk of adverse outcomes, which were mitigated by ABC pathway compliance.

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