Arrhythmias & electrophysiologyCohort study
Association between cardiovascular-kidney-metabolic syndrome and clinical outcomes in patients with atrial fibrillation: Insights from COOL-AF registry
- prospective nationwide registry
Authors' conclusion
In patients with AF, higher stages of CKM syndrome were associated with greater risks of AF-related clinical outcomes, especially HF. Integrated care especially in patients with advanced CKM syndrome improved clinical outcomes.
Study context
- Population
- Patients with atrial fibrillation (AF) classified into cardiovascular-kidney-metabolic (CKM) stages, COOL-AF registrypatients with AF (mean age 67.9 years, standard deviation 11.2, 42.2% female)
- Participants
- 3,235 patients
- Exposure
- Progression of CKM stages compared with patients with CKM grade 0-1
- Outcome
- Composite of:
- All-cause mortality
- Stroke and systemic embolism
- Major bleeding
- Heart failure (HF)
Main finding
As reported in the abstract
aHR
- CKM stage 2
- 1.60
- CKM stage 3
- 2.24
- CKM stage 4
- 2.88
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| HF · greatest risk | 7.54 (2.79–20.40) | |
| 0.050.21520Adjusted hazard ratio (log scale) |
Clinical outcomes with AF Better Care (ABC) pathway compliance in patients with advanced CKM stages
- HR with ABC pathway compliance
- 0.60 (95% confidence interval 0.49-0.73)
- exploratory
Original publication
Association between cardiovascular-kidney-metabolic syndrome and clinical outcomes in patients with atrial fibrillation: Insights from COOL-AF registry. Heart Rhythm. Published 8 May 2026. doi:10.1016/j.hrthm.2026.04.061
Summarised from the published abstract; every number is checked against it