Research Information System
European Journal of Internal Medicine, vol.145, 2026 (SCI-Expanded, Scopus)
Background Cardiovascular, kidney, and metabolic (CKM) conditions frequently coexist with atrial fibrillation (AF), but their impact in AF population remains poorly characterized. Objective To evaluate the prevalence, clinical impact of CKM domains and the effect of integrated care on outcomes in a European cohort of patients with AF. Methods In the EORP-AF General Long-Term Registry, we define CKM domains according to cardiovascular, kidney and metabolic conditions. Patients were stratified by the number and combinations of CKM domains. The primary outcome was a composite of all-cause death, acute coronary syndrome, and thromboembolic events. The impact of adherence to the Atrial fibrillation Better Care (ABC) integrated care pathway was assessed. Results Among 7,736 individuals included in the analysis (39.8 % women; mean age 68.1 [SD 11.6] years), CKM domains were highly prevalent (93.7 % had ≥1 domain; 21.4 % had all three), with regional variation. A higher burden of CKM domains was associated with increased risk of primary outcome events (hazard ratio [HR] [95 % confidence interval] 1 vs 0 domains: HR 1.45 [0.93–2.26]; 2 vs 0: HR 2.05 [1.32–3.19]; 3 vs 0: HR 2.69 [1.71–4.23]). Groups including the cardiovascular domain, especially cardio-kidney, had the highest hazard of events (HR 4.00 [2.41–6.65]). ABC pathway adherence was associated with lower risk of events consistently across number (Pint = 0. 585) and group (Pint = 0.063) of CKM domains. Conclusions In this large cohort of European AF patients, CKM domains were highly prevalent and associated with progressively worse outcomes. ABC-integrated care was associated with favourable outcomes across CKM profiles.