Comorbidity phenotypes, prognostic implications and ABC pathway effectiveness in early-onset atrial fibrillation patients: A latent class analysis from the Tianjin Atrial Fibrillation Project.

Background

Early-onset atrial fibrillation (AF) patients exhibit heterogeneous comorbidity profiles, but they have long been overlooked.

Objective

To identify comorbidity phenotype clusters in younger AF patients and evaluate prognosis and effectiveness of holistic or integrated care management based on the Atrial fibrillation Better Care (ABC) pathway among different phenotypes.

Methods

In this study from the Tianjin Atrial Fibrillation Project, latent class analysis was conducted to determine comorbidity phenotypes in AF patients aged 18-45 years. We investigated the associations between the comorbidity phenotypes, AF management strategies and prognosis. The primary outcome was the composite of all-cause death and major adverse cardiovascular events.

Results

We included 3573 early-onset AF patients (mean age 38.68 ± 5.82 years; 781 [21.9%] female). Three phenotype clusters were identified: (1) Cluster 1: Low Complexity (n=1897, 53.1%); (2) Cluster 2: Multiple Cardiovascular Metabolic Comorbidities (n=1037, 29.0%); (3) Cluster 3: Structural Heart Disease (n=639, 17.9%). During a median follow-up of 1408 days (IQR 496-2532), the risk of the primary outcome was higher in Cluster 2 (HR: 1.94, 95% confidence interval (Cl): 1.56-2.42, P<0.001) and Cluster 3 (HR: 2.63, 95%Cl: 2.15-3.20, P<0.001), compared to Cluster 1. ABC pathway adherence (n=1186 [33.2%] patients) was associated with reduced risk of the primary outcome overall (HR: 0.47, 95%Cl: 0.40-0.56, P<0.001), with similar benefits across different comorbidity phenotypes (Pint = 0.097).

Conclusion

Three heterogeneous comorbidity-based phenotype clusters were identified in early-onset AF patients, associated with different treatment and prognosis. Full ABC pathway adherence improved prognosis in younger AF patients, regardless of their comorbidity phenotypes.