The following is a summary of “Implications of Clinical Risk Phenotypes on the Management and Natural History of Atrial Fibrillation: A Report From the GLORIA‐AF,” published in the October 2023 issue of Cardiology by Romiti et al.

In the realm of atrial fibrillation (AF), the prevalence of clinical risk factors remains high, yet comprehensive data on their impact on oral anticoagulant (OAC) treatment patterns and major outcomes are scarce. They aimed to examine the correlation between distinct clinical risk profiles in AF patients, treatment patterns, and the likelihood of major outcomes.
The GLORIA‐AF (Global Registry on Long‐Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation) encompassed phases 2 and 3, enrolling individuals recently diagnosed with AF between 2011 and 2016. Focusing on patients with CHA₂DS₂‐VASc ≥2, the researchers identified four specific clinical risk traits: elderly individuals (aged ≥80 years), chronic kidney disease (estimated glomerular filtration rate <45 mL/min), history of stroke, and history of bleeding. Their analysis aimed to assess the odds of receiving OAC, the risk of OAC discontinuation, and adverse events during follow-up concerning the combination and cumulative burden of these clinical risk features.

The primary outcome measured was a composite of all-cause death, thromboembolism, and major bleeding. Among the 28,891 participants (mean±SD age, 70.1±10.5 years; 45.5% women), 10,797 (37.3%) exhibited at least one clinical risk feature. Notably, OAC utilization was lower among the elderly group (odds ratio [OR], 0.85 [95% CI, 0.75–0.96]), those with a history of both stroke and bleeding (OR, 0.45 [95% CI, 0.35–0.56]), and individuals with multiple risk features (OR, 0.71 [95% CI, 0.62–0.82]). Moreover, an escalating burden of clinical risk features corresponded with an increased likelihood of OAC discontinuation, especially noticeable in those with ≥3 features (hazard ratio [HR], 1.68 [95% CI, 1.31–2.15]).

Importantly, more complex clinical risk profiles were linked to a higher incidence of the primary composite outcome. Groups with a history of both stroke and bleeding or multiple risk features exhibited the highest figures (adjusted HR, 2.36 [95% CI, 1.83–3.04] and adjusted HR, 2.86 [95% CI, 2.52–3.25], respectively), signifying a poorer prognosis in AF patients associated with these clinical risk phenotypes.

Source: ahajournals.org/doi/10.1161/JAHA.123.030565