Clinical complexity, as the interaction between ageing, frailty, multimorbidity and polypharmacy, is an increasing concern in patients with AF. There remains uncertainty regarding how combinations of comorbidities influence management and prognosis of patients with atrial fibrillation (AF). We aimed to identify phenotypes of AF patients according to comorbidities and to assess associations between comorbidity patterns, drug use and risk of major outcomes. From the prospective GLORIA-AF Registry, we performed a latent class analysis based on 18 diseases, encompassing cardiovascular, metabolic, respiratory and other conditions; we then analysed the association between phenotypes of patients and (i) treatments received and (ii) the risk of major outcomes. Primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). Secondary exploratory outcomes were also analysed. 32,560 AF patients (mean age 70.0 ± 10.5 years, 45.4% females) were included. We identified 6 phenotypes: (i) low complexity (39.2% of patients); (ii) cardiovascular (CV) risk factors (28.2%); (iii) atherosclerotic (10.2%); (iv) thromboembolic (8.1%); (v) cardiometabolic (7.6%) and (vi) high complexity (6.6%). Higher use of oral anticoagulants was found in more complex groups, with highest magnitude observed for the cardiometabolic and high complexity phenotypes (odds ratio and 95% confidence interval CI): 1.76 [1.49–2.09] and 1.57 [1.35–1.81], respectively); similar results were observed for beta-blockers and verapamil or diltiazem. We found higher risk of the primary outcome in all phenotypes, except the CV risk factor one, with highest risk observed for the cardiometabolic and high complexity groups (hazard ratio and 95%CI: 1.37 [1.13–1.67] and 1.47 [1.24–1.75], respectively). Comorbidities influence management and long-term prognosis of patients with AF. Patients with complex phenotypes may require comprehensive and holistic approaches to improve their prognosis.

中文翻译：

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房颤患者合并症的模式及其对治疗和长期预后的影响：来自前瞻性全球 GLORIA-AF 注册中心的分析

临床复杂性，即衰老、虚弱、多病和多药治疗之间的相互作用，越来越受到 AF 患者的关注。关于合并症的组合如何影响心房颤动（AF）患者的治疗和预后仍存在不确定性。我们的目的是根据合并症识别 AF 患者的表型，并评估合并症模式、药物使用和主要结局风险之间的关联。根据前瞻性 GLORIA-AF 登记库，我们对 18 种疾病进行了潜在类别分析，涵盖心血管、代谢、呼吸和其他疾病；然后，我们分析了患者表型与（i）接受的治疗和（ii）主要结果风险之间的关联。主要结局是全因死亡和主要不良心血管事件（MACE）的复合结果。还分析了次要探索结果。纳入 32,560 名 AF 患者（平均年龄 70.0 ± 10.5 岁，45.4% 为女性）。我们确定了 6 种表型：(i) 低复杂性（39.2% 的患者）； (ii) 心血管（CV）危险因素（28.2%）； (iii) 动脉粥样硬化（10.2%）； (iv) 血栓栓塞（8.1%）； (v) 心脏代谢 (7.6%) 和 (vi) 高复杂性 (6.6%)。在更复杂的群体中发现口服抗凝剂的使用率更高，在心脏代谢和高复杂性表型中观察到最高程度（比值比和 95% 置信区间 CI）：分别为 1.76 [1.49–2.09] 和 1.57 [1.35–1.81]） ; β-受体阻滞剂和维拉帕米或地尔硫卓也观察到类似的结果。我们发现除心血管危险因素一外，所有表型的主要结局风险较高，心脏代谢组和高复杂性组的风险最高（风险比和 95% CI：1.37 [1.13–1.67] 和 1.47 [1.24–1.75] ]， 分别）。合并症影响 AF 患者的治疗和长期预后。具有复杂表型的患者可能需要全面、整体的方法来改善其预后。