van Deutekom Colinda, Velt Marieke J H, van Gelder Isabelle C, Rienstra Michiel, Mulder Bart A
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Int J Cardiol Heart Vasc. 2025 Apr 24;59:101686. doi: 10.1016/j.ijcha.2025.101686. eCollection 2025 Aug.
Multimorbidity is common in patients with atrial fibrillation (AF), but data on its prevalence and impact in permanent AF is limited. This study aimed to investigate the prevalence of multimorbidity and its association with cardiovascular outcomes in recent-onset permanent AF.
The RACE II study was a randomized controlled trial comparing strict and lenient rate-control in 614 patients with recent-onset permanent AF. Presence of nine comorbidities was assessed and the population divided into three groups based on the number of comorbidities (0-1, 2-3, ≥4). Cox regression analyses were conducted to assess the association between the number of comorbidities and the primary composite outcome (cardiovascular mortality, hospitalization for heart failure, stroke and/or systemic embolism, major bleeding, arrhythmic events). Kaplan-Meier estimates for the cumulative risk of the first event were calculated and plotted.
Mean age was 68 ± 8 years and 211 (34 %) were women. In this population, 213 (35 %) patients had 0-1 comorbidity, 313 (51 %) 2-3, and 88 (14 %) ≥ 4. During 3 years follow-up, 81 patients (13 %) reached the primary composite outcome. Patients with more comorbidities more frequently reached the primary composite outcome (P < 0.001), as well as cardiovascular mortality (P = 0.049), heart failure hospitalizations (P = 0.003), and stroke/systemic embolism (P = 0.024). The presence of ≥ 4 comorbidities was associated with a higher risk of the primary composite outcome compared to the presence of 0-1 comorbidity (HR 2.27, 95 % CI (1.21-4.23), P = 0.010).
Multimorbidity was present in two-thirds of recent-onset permanent AF patients, with a higher number of comorbidities associated with greater risk of cardiovascular outcomes.
多重疾病在心房颤动（AF）患者中很常见，但关于其在永久性AF中的患病率和影响的数据有限。本研究旨在调查近期发病的永久性AF中多重疾病的患病率及其与心血管结局的关联。
RACE II研究是一项随机对照试验，比较了614例近期发病的永久性AF患者的严格和宽松心率控制。评估了九种合并症的存在情况，并根据合并症数量将人群分为三组（0-1、2-3、≥4）。进行Cox回归分析以评估合并症数量与主要复合结局（心血管死亡率、因心力衰竭住院、中风和/或全身性栓塞、大出血、心律失常事件）之间的关联。计算并绘制了首次事件累积风险的Kaplan-Meier估计值。
平均年龄为68±8岁，211名（34%）为女性。在该人群中，213名（35%）患者有0-1种合并症，313名（51%）有2-3种，88名（14%）≥4种。在3年的随访期间，81名患者（13%）达到了主要复合结局。合并症较多的患者更频繁地达到主要复合结局（P<0.001），以及心血管死亡率（P=0.049）、心力衰竭住院率（P=0.003）和中风/全身性栓塞（P=0.024）。与有0-1种合并症相比，≥4种合并症的存在与主要复合结局的较高风险相关（HR 2.27，95%CI（1.21-4.23），P=0.010）。
三分之二的近期发病的永久性AF患者存在多重疾病，合并症数量越多，心血管结局风险越高。
