{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:21:43Z","timestamp":1792686103313,"version":"4.5.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Growing evidence showing that systemic autoimmune diseases (SADs) are associated with a high risk of atrial fibrillation (AF). However, the impact of SAD on the clinical course of AF patients is largely unknown.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective cohort study within a federated healthcare network (TriNetX). Using ICD codes, AF patients on anticoagulant therapy were categorized according to the presence of SAD (M32: Systemic Lupus Erythematosus (SLE); M33: Dermato-polymyositis (DMP); M34: Systemic Sclerosis (SSc); M35: Sjogren syndrome). The primary outcomes were the 5-year risks of (1) all-cause death, (2) thrombotic events (ischemic stroke, acute myocardial infarction, deep vein thrombosis, and pulmonary embolism), and (3) bleeding (intracranial (ICH) and gastrointestinal (GI)). Secondary outcomes were each component of the primary outcomes. Cox regression analysis after propensity score matching (PSM) was used to estimate hazard ratio (HR) and 95% confidence interval (95%CI).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We identified 16,098 AF patients with SAD (68.2\u2009\u00b1\u200913.4\u00a0years; 71.0% female) and 828,772 AF controls (70.7\u2009\u00b1\u200912.9\u00a0years, 41.1% females). After PSM, AF patients with SAD were associated with a higher risk of all-cause death (HR 1.13, 95%CI 1.09\u20131.71), thrombotic events (HR 1.37, 95%CI 1.32\u20131.43), and hemorrhagic events (HR 1.41, 95%CI 1.33\u20131.50) compared to AF controls without SAD. The highest risk of all-cause death and GI bleeding was associated with SSc, while the highest risk of thrombotic events and ICH was associated with SLE.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>AF patients with SAD are associated with a high risk of all-cause death, thrombotic, and hemorrhagic events. These patients merit careful follow-up and integrated care management to improve their prognosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00392-024-02426-1","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T11:03:00Z","timestamp":1709722980000},"page":"942-950","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Risk of death, thrombotic and hemorrhagic events in anticoagulated patients with atrial fibrillation and systemic autoimmune diseases: an analysis from a global federated dataset"],"prefix":"10.1007","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2895-6234","authenticated-orcid":false,"given":"Tommaso","family":"Bucci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Cardamone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Triggiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R. J.","family":"Ames","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"issue":"3","key":"2426_CR1","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1093\/europace\/euac244","volume":"25","author":"MJ Tilly","year":"2023","unstructured":"Tilly MJ, Geurts S, Zhu F et al (2023) Autoimmune diseases and new-onset atrial fibrillation: a UK Biobank study. Europace 25(3):804\u2013811","journal-title":"Europace"},{"issue":"20","key":"2426_CR2","doi-asserted-by":"publisher","first-page":"1969","DOI":"10.1016\/j.jacc.2023.09.802","volume":"82","author":"G Sun","year":"2023","unstructured":"Sun G, Ahlehoff O, Fosbol EL et al (2023) Long-term incidence of atrial fibrillation in patients with autoimmune disease. J Am Coll Cardiol 82(20):1969\u20131971","journal-title":"J Am Coll Cardiol"},{"issue":"23","key":"2426_CR3","doi-asserted-by":"publisher","first-page":"2349","DOI":"10.1016\/j.jacc.2022.03.379","volume":"79","author":"A Ajoolabady","year":"2022","unstructured":"Ajoolabady A, Nattel S, Lip GYH, Ren J (2022) Inflammasome signaling in atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol 79(23):2349\u20132366","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"2426_CR4","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1253\/circj.CJ-19-0705","volume":"84","author":"M Gawalko","year":"2020","unstructured":"Gawalko M, Balsam P, Lodzinski P et al (2020) Cardiac arrhythmias in autoimmune diseases. Circ J 84(5):685\u2013694","journal-title":"Circ J"},{"issue":"10354","key":"2426_CR5","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1016\/S0140-6736(22)01349-6","volume":"400","author":"N Conrad","year":"2022","unstructured":"Conrad N, Verbeke G, Molenberghs G et al (2022) Autoimmune diseases and cardiovascular risk: a population-based study on 19 autoimmune diseases and 12 cardiovascular diseases in 22 million individuals in the UK. Lancet 400(10354):733\u2013743","journal-title":"Lancet"},{"issue":"9","key":"2426_CR6","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1161\/01.ATV.0000174800.78362.ec","volume":"25","author":"J Frostegard","year":"2005","unstructured":"Frostegard J (2005) Atherosclerosis in patients with autoimmune disorders. Arterioscler Thromb Vasc Biol 25(9):1776\u20131785","journal-title":"Arterioscler Thromb Vasc Biol"},{"issue":"2","key":"2426_CR7","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1378\/chest.09-1584","volume":"137","author":"GY Lip","year":"2010","unstructured":"Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 137(2):263\u2013272","journal-title":"Chest"},{"issue":"2","key":"2426_CR8","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.amjmed.2010.05.007","volume":"124","author":"GY Lip","year":"2011","unstructured":"Lip GY (2011) Implications of the CHA(2)DS(2)-VASc and HAS-BLED scores for thromboprophylaxis in atrial fibrillation. Am J Med 124(2):111\u2013114","journal-title":"Am J Med"},{"issue":"1","key":"2426_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2042-6410-2-1","volume":"2","author":"R Voskuhl","year":"2011","unstructured":"Voskuhl R (2011) Sex differences in autoimmune diseases. Biol Sex Differ 2(1):1","journal-title":"Biol Sex Differ"},{"issue":"suppl_1","key":"2426_CR10","first-page":"i67","volume":"56","author":"MJ Lewis","year":"2017","unstructured":"Lewis MJ, Jawad AS (2017) The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology (Oxford) 56(suppl_1):i67\u2013i77","journal-title":"Rheumatology (Oxford)"},{"issue":"1","key":"2426_CR11","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1186\/s12916-022-02544-5","volume":"20","author":"A Sharma-Oates","year":"2022","unstructured":"Sharma-Oates A, Zemedikun DT, Kumar K et al (2022) Early onset of immune-mediated diseases in minority ethnic groups in the UK. BMC Med 20(1):346","journal-title":"BMC Med"},{"issue":"11","key":"2426_CR12","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.2105\/AJPH.2009.180273","volume":"100","author":"SL Thomas","year":"2010","unstructured":"Thomas SL, Griffiths C, Smeeth L, Rooney C, Hall AJ (2010) Burden of mortality associated with autoimmune diseases among females in the United Kingdom. Am J Public Health 100(11):2279\u20132287","journal-title":"Am J Public Health"},{"issue":"3","key":"2426_CR13","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1093\/rheumatology\/keaa537","volume":"60","author":"M Mitratza","year":"2021","unstructured":"Mitratza M, Klijs B, Hak AE, Kardaun J, Kunst AE (2021) Systemic autoimmune disease as a cause of death: mortality burden and comorbidities. Rheumatology (Oxford) 60(3):1321\u20131330","journal-title":"Rheumatology (Oxford)"},{"key":"2426_CR14","doi-asserted-by":"publisher","unstructured":"Albrecht K, Redeker I, Aringer M, Marschall U, Strangfeld A, Callhoff J (2021) Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort. Lupus Sci Med 8(1). https:\/\/doi.org\/10.1136\/lupus-2021-000526","DOI":"10.1136\/lupus-2021-000526"},{"issue":"8","key":"2426_CR15","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1093\/eurheartj\/ehu403","volume":"36","author":"JC Mason","year":"2015","unstructured":"Mason JC, Libby P (2015) Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J 36(8):482\u2013489","journal-title":"Eur Heart J"},{"issue":"2","key":"2426_CR16","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1055\/s-0038-1661387","volume":"45","author":"JF Borjas-Howard","year":"2019","unstructured":"Borjas-Howard JF, Leeuw K, Rutgers A, Meijer K, Tichelaar V (2019) Risk of recurrent venous thromboembolism in autoimmune diseases: a systematic review of the literature. Semin Thromb Hemost 45(2):141\u2013149","journal-title":"Semin Thromb Hemost"},{"issue":"1","key":"2426_CR17","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.thromres.2014.10.012","volume":"135","author":"HR Yusuf","year":"2015","unstructured":"Yusuf HR, Hooper WC, Grosse SD, Parker CS, Boulet SL, Ortel TL (2015) Risk of venous thromboembolism occurrence among adults with selected autoimmune diseases: a study among a U.S. cohort of commercial insurance enrollees. Thromb Res 135(1):50\u20137","journal-title":"Thromb Res"},{"issue":"3","key":"2426_CR18","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s11239-014-1050-0","volume":"38","author":"HR Yusuf","year":"2014","unstructured":"Yusuf HR, Hooper WC, Beckman MG, Zhang QC, Tsai J, Ortel TL (2014) Risk of venous thromboembolism among hospitalizations of adults with selected autoimmune diseases. J Thromb Thrombolysis 38(3):306\u2013313","journal-title":"J Thromb Thrombolysis"},{"key":"2426_CR19","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.ejim.2020.10.017","volume":"84","author":"Y Yamashita","year":"2021","unstructured":"Yamashita Y, Morimoto T, Kadota K, Ono K, Kimura T (2021) Autoimmune disorders and venous thromboembolism: an update from the COMMAND VTE registry. Eur J Intern Med 84:106\u2013108","journal-title":"Eur J Intern Med"},{"key":"2426_CR20","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/1471-2377-12-41","volume":"12","author":"B Zoller","year":"2012","unstructured":"Zoller B, Li X, Sundquist J, Sundquist K (2012) Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. BMC Neurol 12:41","journal-title":"BMC Neurol"},{"issue":"1","key":"2426_CR21","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s13075-015-0552-2","volume":"17","author":"S Van Doornum","year":"2015","unstructured":"Van Doornum S, Bohensky M, Tacey MA, Brand CA, Sundararajan V, Wicks IP (2015) Increased 30-day and 1-year mortality rates and lower coronary revascularisation rates following acute myocardial infarction in patients with autoimmune rheumatic disease. Arthritis Res Ther 17(1):38","journal-title":"Arthritis Res Ther"},{"key":"2426_CR22","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12959-015-0043-3","volume":"13","author":"M Bazzan","year":"2015","unstructured":"Bazzan M, Vaccarino A, Marletto F (2015) Systemic lupus erythematosus and thrombosis. Thromb J 13:16","journal-title":"Thromb J"},{"issue":"3","key":"2426_CR23","first-page":"461","volume":"55","author":"SK Rai","year":"2016","unstructured":"Rai SK, Choi HK, Sayre EC, Avina-Zubieta JA (2016) Risk of myocardial infarction and ischaemic stroke in adults with polymyositis and dermatomyositis: a general population-based study. Rheumatology (Oxford) 55(3):461\u2013469","journal-title":"Rheumatology (Oxford)"},{"issue":"4","key":"2426_CR24","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1093\/brain\/98.4.637","volume":"98","author":"R DeVere","year":"1975","unstructured":"DeVere R, Bradley WG (1975) Polymyositis: its presentation, morbidity and mortality. Brain 98(4):637\u2013666","journal-title":"Brain"},{"issue":"11","key":"2426_CR25","doi-asserted-by":"publisher","first-page":"3021","DOI":"10.1007\/s10067-023-06686-6","volume":"42","author":"CS Santos","year":"2023","unstructured":"Santos CS, Salgueiro RR, Morales CM, Castro CA, Alvarez ED (2023) Risk factors for cardiovascular disease in primary Sjogren\u2019s syndrome (pSS): a 20-year follow-up study. Clin Rheumatol 42(11):3021\u20133031","journal-title":"Clin Rheumatol"},{"issue":"4","key":"2426_CR26","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1002\/acr.21846","volume":"65","author":"YS Chang","year":"2013","unstructured":"Chang YS, Liu CJ, Chen WS et al (2013) Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus: a nationwide population-based study. Arthritis Care Res (Hoboken) 65(4):601\u2013606","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"2426_CR27","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s13075-019-2078-5","volume":"21","author":"YT Lin","year":"2019","unstructured":"Lin YT, Chuang YS, Wang JW, Wu PH (2019) High risk of gastrointestinal hemorrhage in patients with systemic sclerosis. Arthritis Res Ther 21(1):301","journal-title":"Arthritis Res Ther"},{"issue":"1","key":"2426_CR28","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s10067-019-04588-0","volume":"39","author":"A Michel","year":"2020","unstructured":"Michel A, Gonzalez-Perez A, Saez ME, Garcia Rodriguez LA (2020) Risk of bleeding events among patients with systemic sclerosis and the general population in the UK: a large population-based cohort study. Clin Rheumatol 39(1):19\u201326","journal-title":"Clin Rheumatol"},{"key":"2426_CR29","doi-asserted-by":"publisher","unstructured":"Favaloro EJ, Pasalic L, Lippi G (2022) Autoimmune diseases affecting hemostasis: a narrative review. Int J Mol Sci 23(23). https:\/\/doi.org\/10.3390\/ijms232314715","DOI":"10.3390\/ijms232314715"},{"issue":"6","key":"2426_CR30","doi-asserted-by":"publisher","first-page":"2070","DOI":"10.1093\/rheumatology\/keac650","volume":"62","author":"PRJ Ames","year":"2023","unstructured":"Ames PRJ, Bucci T, Merashli M, Arcaro A, Gentile F (2023) Thrombocytopaenia in antiphospholipid syndrome: a free radical perspective. Rheumatology (Oxford) 62(6):2070\u20132075","journal-title":"Rheumatology (Oxford)"},{"issue":"1","key":"2426_CR31","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1055\/s-0041-1739411","volume":"122","author":"TF Chao","year":"2022","unstructured":"Chao TF, Joung B, Takahashi Y et al (2022) 2021 Focused update consensus guidelines of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation: executive summary. Thromb Haemost 122(1):20\u201347","journal-title":"Thromb Haemost"},{"issue":"3","key":"2426_CR32","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1055\/a-1515-9630","volume":"122","author":"GF Romiti","year":"2022","unstructured":"Romiti GF, Pastori D, Rivera-Caravaca JM et al (2022) Adherence to the \u2018Atrial Fibrillation Better Care\u2019 pathway in patients with atrial fibrillation: impact on clinical outcomes-a systematic review and meta-analysis of 285,000 patients. Thromb Haemost 122(3):406\u2013414","journal-title":"Thromb Haemost"},{"issue":"4","key":"2426_CR33","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1016\/j.jacasi.2023.04.008","volume":"3","author":"T Bucci","year":"2023","unstructured":"Bucci T, Proietti M, Shantsila A et al (2023) Integrated care for atrial fibrillation using the ABC pathway in the prospective APHRS-AF registry. JACC Asia 3(4):580\u2013591","journal-title":"JACC Asia"}],"container-title":["Clinical Research in Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-024-02426-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00392-024-02426-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-024-02426-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T07:06:13Z","timestamp":1716275173000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00392-024-02426-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,6]]},"references-count":33,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["2426"],"URL":"https:\/\/doi.org\/10.1007\/s00392-024-02426-1","relation":{},"ISSN":["1861-0684","1861-0692"],"issn-type":[{"value":"1861-0684","type":"print"},{"value":"1861-0692","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,6]]},"assertion":[{"value":"19 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"GYHL is a consultant and speaker for BMS\/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos. No fees are received personally. He is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union\u2019s Horizon 2020 research and innovation programme under grant agreement No 899871. All other authors report no disclosures.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}