Cardiometabolic multimorbidity tied to worse outcomes, bleeding in AF patients

Atrial fibrillation (AF) patients with cardiometabolic multimorbidity appear to experience worse outcomes and severe bleeding, a study has found.

The investigators identified patients with nonvalvular AF aged ≥75 years in the Market Scan Medicare Supplemental database from 2007–2015. They obtained the prevalence of 14 chronic conditions at the time of AF diagnosis and classified these as either cardiometabolic or noncardiometabolic.

Cox regression was used to estimate the associations of the number and type of conditions with stroke, severe bleeding, and heart failure hospitalizations. Tests for interaction were also examined between AF treatments and multimorbidity.

Overall, 275,617 patients with AF (mean age, 83 years; 51 percent women) were included; each participant had a mean of 3.0 conditions. A total of 7,814 strokes, 13,622 severe bleeds, and 19,252 heart failure events occurred over a mean follow-up of 23 months.

After adjustment, increases in the number of cardiometabolic conditions correlated with a higher risk of stroke (hazard ratio [HR], 1.07, 95 percent confidence interval [CI], 1.05–1.10), severe bleeding (HR, 1.09, 95 percent CI, 1.07–1.11), and heart failure (HR, 1.19, 95 percent CI, 1.18–1.20).

On the other hand, the number of noncardiometabolic conditions showed weak or null associations with the risk of cardiovascular endpoints.

The effectiveness of AF treatment on stroke and heart failure, in general, was similar across multimorbidity status. However, patients with overall and subgroup multimorbidity had higher bleeding risk associated with AF treatments.

“These findings underscore the impact of cardiometabolic conditions on AF outcomes and highlight the need to incorporate multimorbidity management in AF treatment guidelines,” the investigators said.