Clinical associations and prognosis in Asian and European patients with symptom-controlled atrial fibrillation: Insights from two prospective registries in Europe and Asia

Abstract

Background: Clinical associations and prognosis of patients with symptom-controlled AF (scAF) remain poorly understood. Methods: We analysed data from the Asian-Pacific Heart Rhythm Society and EURObservational Research Programme registries. Based on the European Heart Rhythm Association (EHRA) score, patients were classified as scAF (EHRA I or II) or symptomatic AF (EHRA III or IV). Clinical characteristics were examined by logistic regression, and prognosis was assessed by Cox models. The primary outcome was composed of all-cause death and major cardiovascular events. Interaction analyses were performed to investigate ethnic differences. Results: Among 13,577 AF patients (mean age 69.0 ± 11.6 years; 38.7% female), 11,470 (84.5%) had scAF. Asians were more likely to be scAF, characterised by younger age and lower cardiovascular burden compared to Europeans. Diabetes mellitus was significantly associated with scAF only in Asians (adjusted odd ratio [aOR] 1.43, 95% confidence interval [CI] 1.03–2.04, pinteraction = 0.021). The associations with hypertension (aOR 1.29, 95% CI 0.98–1.70, pinteraction = 0.004) and prior ischemic stroke (aOR 1.75, 95% CI 0.96–3.58, pinteraction = 0.045) were more evident in Asians. Patients with scAF showed a notable association with increased likelihood of using vitamin K antagonists (aOR 1.19, 95% CI 1.07–1.33), which was more prominent in Asians. In both Asians and Europeans, scAF was associated with reduced rhythm control management. Compared to non-scAF, European patients with scAF had a reduced risk of the composite outcome, but the association was non-significant in Asians (pinteraction = 0.594). Conclusion: Asians and Europeans with scAF demonstrate clinically relevant differences in terms of overall prevalence, related risk factors, and clinical management.