Cardiovascular-kidney-metabolic syndrome and atrial fibrillation: Insights from 2 real-world prospective registries across Europe and East Asia

BACKGROUND: Patients with atrial fibrillation (AF) commonly present with other comorbidities, including metabolic, kidney, or cardiovascular risk factors, which have a complex interplay leading to increased mortality and morbidity. OBJECTIVE: The purpose of this study was to evaluate the association between cardiovascular-kidney-metabolic (CKM) syndrome stages and adverse clinical outcomes in AF. METHODS: Patients with AF with available data for CKM staging were included from the EURObservational Research Programme (EORP) AF General Long-Term Registry and Asia-Pacific Heart Rhythm Society (APHRS) AF Registry. Patients were stratified into 3 CKM risk categories based on the stage: (1) low CKM risk (CKM stage 2), (2) moderate CKM risk (CKM stage 3), and (3) high CKM risk (CKM stage 4). Univariate and multivariable Cox regression analysis were performed to assess the associations between CKM risk status and the adverse clinical outcomes. RESULTS: In total, 5577 patients (age 71.5 years, standard deviation 10.3; 59.0% male) were enrolled: of these, low, moderate, and high CKM risk groups were present in 1090 (19.5%), 159 (2.9%), and 4328 (77.6%) patients, respectively. Patients in the high-risk group had significantly higher risk of composite outcome (adjusted hazard ratio [aHR] 1.93; 95% confidence interval [CI] 1.58-2.36), all-cause death (aHR 1.90; 95% CI 1.48-2.45), and major adverse cardiovascular events (MACE) (aHR 2.28; 95% CI 1.73-3.00) than did the low CKM risk group. The patients with high CKM risk experienced greater hazards of MACE (aHR 3.49 95% CI 1.44-8.42) than did those with moderate CKM risk. CONCLUSION: High CKM risk was associated with an increased risk of all-cause death and MACE. A holistic or integrated care approach management strategy is recommended to improve clinical outcomes in these patients.