Arrhythmias & electrophysiologyCohort study
Cardiovascular-kidney-metabolic interplay in patients with atrial fibrillation receiving direct oral anticoagulants
- Retrospective cohort study
- multicentre
Authors' conclusion
Increasing CKM burden was associated with progressively worse prognosis and shorter life expectancy in AF patients on DOACs, with more pronounced impacts in women.
Study context
- Population
- Patients with non-valvular atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs), multicentre Taiwanese database (2012–21)
- Participants
- 17,378 patients
- Exposure
- 3 cardiovascular-kidney-metabolic (CKM) domains vs 0 CKM domains
- Outcome
- Clinical outcomes and years of life lost (YLL) per death by number, components and complexity of CKM domains
Main finding
As reported in the abstract
Outcomes by number of CKM domains
0 domains
18.1
% of patients
1 domain
35.1
% of patients
2 domains
32.2
% of patients
3 domains
14.6%
of patients
3 domains vs 0 domainsAdjusted hazard ratio (95% CI)P value
IS/SEE/ACS
1.60(1.25–2.05)
P < 0.001major bleeding
2.60(2.00–3.38)
P < 0.001HF hospitalization
2.83(2.38–3.37)
P < 0.001all-cause mortality
1.80(1.58–2.06)
P < 0.001AKI
3.42(2.76–4.25)
P < 0.001major adverse renal events
20.84(14.14–30.71)
P < 0.001Observational data: associations, not effects.
Further findings
Domain-specific risks
- Kidney involvement conferred the strongest risks (except IS/SEE/ACS); CV and metabolic domains more associated with IS/SEE/ACS
Years of life lost (YLL) by sex
- YLL rose with more CKM domains; greater reductions in females, CV domain (females vs males)
- −10.29 vs. −4.67
- Metabolic domain (females vs males)
- −4.98 vs. −0.80
- P < 0.001
Original publication
Cardiovascular-kidney-metabolic interplay in patients with atrial fibrillation receiving direct oral anticoagulants. Europace. Published 19 February 2026. doi:10.1093/europace/euag028
Summarised from the published abstract; every number is checked against it