{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:03:13Z","timestamp":1793811793626,"version":"4.6.1"},"reference-count":29,"publisher":"Elsevier BV","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013238","name":"Mahidol University Faculty of Medicine Siriraj Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013238","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010724","name":"Health System Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010724","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["JACC: Asia"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.jacasi.2026.05.016","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T21:01:12Z","timestamp":1782939672000},"page":"2080-2093","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"title":["Multimorbidity Status Worsening and Clinical Outcomes of Patients With Atrial Fibrillation"],"prefix":"10.1016","volume":"6","author":[{"given":"Satchana","family":"Pumprueg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahthit","family":"Yindeengam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y.H.","family":"Lip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8684-2361","authenticated-orcid":false,"given":"Rungroj","family":"Krittayaphong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jacasi.2026.05.016_bib1","article-title":"Atrial fibrillation: epidemiology, screening and digital health","volume":"37","author":"Linz","year":"2024","journal-title":"Lancet Reg Health Eur"},{"key":"10.1016\/j.jacasi.2026.05.016_bib2","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1055\/a-2690-1674","article-title":"Racial differences in bleeding risks among patients with atrial fibrillation: an ecological epidemiological study comparing Korea and UK population","volume":"126","author":"Kang","year":"2026","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib3","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1055\/a-2269-1123","article-title":"Racial differences in bleeding risk: an ecological epidemiological study comparing Korea and United Kingdom subjects","volume":"124","author":"Kang","year":"2024","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib4","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1016\/j.mayocp.2019.06.012","article-title":"Long-term relationship between atrial fibrillation, multimorbidity and oral anticoagulant drug use","volume":"94","author":"Proietti","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"10.1016\/j.jacasi.2026.05.016_bib5","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1055\/s-0043-1769735","article-title":"The impact of polypharmacy on the effectiveness and safety of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation","volume":"124","author":"Grymonprez","year":"2024","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib6","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"10.1016\/j.jacasi.2026.05.016_bib7","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jacc.2023.08.017","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the diagnosis and management of atrial fibrillation: a report of the American college of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"83","author":"Writing Committee","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jacasi.2026.05.016_bib8","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1055\/s-0041-1739411","article-title":"2021 Focused Update Consensus Guidelines of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation: executive summary","volume":"122","author":"Chao","year":"2022","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib9","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1055\/a-2325-5923","volume":"124","author":"Wang","year":"2024","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib10","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1038\/nrcardio.2017.153","article-title":"The ABC pathway: an integrated approach to improve AF management","volume":"14","author":"Lip","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"10.1016\/j.jacasi.2026.05.016_bib11","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1055\/a-1515-9630","article-title":"Adherence to the \u2018Atrial Fibrillation Better Care\u2019 pathway in patients with atrial fibrillation: impact on clinical outcomes\u2014a systematic review and meta-analysis of 285,000 patients","volume":"122","author":"Romiti","year":"2022","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib12","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1055\/s-0043-1769612","article-title":"Mobile health-technology-integrated care for atrial fibrillation: a win ratio analysis from the mAFA-II randomized clinical trial","volume":"123","author":"Romiti","year":"2023","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1055\/s-0043-1772773","article-title":"Non-vitamin K antagonist oral anticoagulant, warfarin, and ABC pathway adherence on hierarchical outcomes: win ratio analysis of the COOL-AF registry","volume":"124","author":"Treewaree","year":"2024","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib14","doi-asserted-by":"crossref","DOI":"10.1038\/s41591-025-03511-2","article-title":"Telemedicine-based integrated management of atrial fibrillation in village clinics: a cluster randomized trial","author":"Chu","year":"2025","journal-title":"Nat Med"},{"key":"10.1016\/j.jacasi.2026.05.016_bib15","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.jacc.2017.10.085","article-title":"Relationship of aging and incident comorbidities to stroke risk in patients with atrial fibrillation","volume":"71","author":"Chao","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.jacasi.2026.05.016_bib16","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1055\/s-0038-1636534","article-title":"Incident risk factors and major bleeding in patients with atrial fibrillation treated with oral anticoagulants: a comparison of baseline, follow-up and delta HAS-BLED scores with an approach focused on modifiable bleeding risk factors","volume":"118","author":"Chao","year":"2018","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib17","article-title":"Comparing CHA(2)DS(2)-VA and CHA(2)DS(2)-VASc scores for stroke risk stratification in patients with atrial fibrillation: a temporal trends analysis from the retrospective Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) cohort","volume":"43","author":"Teppo","year":"2024","journal-title":"Lancet Reg Health Eur"},{"key":"10.1016\/j.jacasi.2026.05.016_bib18","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.1016\/j.hrthm.2025.05.067","article-title":"Stroke risks in women vs men in Asian patients with atrial fibrillation: a temporal trend analysis and a comparison of the CHA(2)DS(2)-VASc and CHA(2)DS(2)-VA stroke risk stratification scores","volume":"22","author":"Cheng","year":"2025","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.jacasi.2026.05.016_bib19","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest"},{"key":"10.1016\/j.jacasi.2026.05.016_bib20","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1055\/a-2595-5575","article-title":"Patient care pathways and risk assessments in patients with atrial fibrillation: a comparison of Asian versus non-Asian cohorts","volume":"125","author":"Chang","year":"2025","journal-title":"Thromb Haemost"},{"key":"10.1016\/j.jacasi.2026.05.016_bib21","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.028463","article-title":"Impact of achieving blood pressure targets and high time in therapeutic range on clinical outcomes in patients with atrial fibrillation adherent to the atrial fibrillation better care pathway: a report from the COOL-AF registry","volume":"12","author":"Krittayaphong","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.jacasi.2026.05.016_bib22","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae237","article-title":"Components of the atrial fibrillation better care pathway for holistic care of patients with atrial fibrillation: a win ratio analysis from the COOL-AF registry","volume":"26","author":"Krittayaphong","year":"2024","journal-title":"Europace"},{"key":"10.1016\/j.jacasi.2026.05.016_bib23","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.026410","article-title":"Incidence and risk factors for residual adverse events despite anticoagulation in atrial fibrillation: results from phase II\/III of the GLORIA-AF registry","volume":"11","author":"Ding","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.jacasi.2026.05.016_bib24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0282455","article-title":"Causes of death of patients with non-valvular atrial fibrillation in Asians","volume":"18","author":"Krittayaphong","year":"2023","journal-title":"PLoS One"},{"key":"10.1016\/j.jacasi.2026.05.016_bib25","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0191592","article-title":"Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: rationale for comprehensive management of atrial fibrillation","volume":"13","author":"Bassand","year":"2018","journal-title":"PLoS One"},{"key":"10.1016\/j.jacasi.2026.05.016_bib26","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.jchf.2023.11.016","article-title":"Tachycardia and atrial fibrillation-related cardiomyopathies: potential mechanisms and current therapies","volume":"12","author":"Keefe","year":"2024","journal-title":"JACC Heart Fail"},{"key":"10.1016\/j.jacasi.2026.05.016_bib27","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1002\/ehf2.15093","article-title":"Importance of non-cardiovascular comorbidities in atrial fibrillation and heart failure with preserved ejection fraction","volume":"12","author":"Hamatani","year":"2025","journal-title":"ESC Heart Fail"},{"key":"10.1016\/j.jacasi.2026.05.016_bib28","doi-asserted-by":"crossref","first-page":"e277","DOI":"10.1016\/j.hrthm.2025.02.013","article-title":"Racial differences and similarities in atrial fibrillation epidemiology and risk factors in UK Biobank and Korean NHIS-HEALS cohort studies","volume":"22","author":"Kim","year":"2025","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.jacasi.2026.05.016_bib29","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1055\/a-2278-8769","article-title":"Racial differences in ischemic and hemorrhagic stroke: an ecological epidemiological study","volume":"124","author":"Kang","year":"2024","journal-title":"Thromb Haemost"}],"container-title":["JACC: Asia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772374726003558?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772374726003558?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:14:41Z","timestamp":1789600481000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2772374726003558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":29,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["S2772374726003558"],"URL":"https:\/\/doi.org\/10.1016\/j.jacasi.2026.05.016","relation":{},"ISSN":["2772-3747"],"issn-type":[{"value":"2772-3747","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Multimorbidity Status Worsening and Clinical Outcomes of Patients With Atrial Fibrillation","name":"articletitle","label":"Article Title"},{"value":"JACC: Asia","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacasi.2026.05.016","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.","name":"copyright","label":"Copyright"}]}}