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The interplay between frailty and comorbidity in AF remains underexplored, particularly regarding quality of life (QoL), health management, and outcome prioritization. Within the AFFIRMO project, this study investigated the experiences of older adults with AF and at least one chronic condition via an online survey. Frailty was assessed using the FRAIL questionnaire, and participants were grouped by frailty status and number of comorbidities. Health-related quality of life (HRQoL) was measured using the EQ-5D-3L and Visual Analogue Scale (VAS). Challenges in health management and prioritized outcomes were also explored. We included 659 participants (median age 72\u00a0years, 52.8% female). Those with pre-frailty or frailty and \u2265\u20093 comorbidities reported the poorest HRQoL. Comorbidity, particularly combined with frailty, was associated with health management difficulties, including healthcare visits, polypharmacy, and mobility limitations. Across all groups, maintaining independence and improving QoL were prioritized outcomes. Pain relief was especially important for those with higher comorbidities. In older adults with AF, comorbidity and frailty significantly affect QoL and health burden. Tailored, patient-centred care strategies and routine assessment of frailty and comorbidity are essential to improve care coordination and outcomes.<\/jats:p>","DOI":"10.1038\/s41598-026-44800-1","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T10:27:05Z","timestamp":1774866425000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The role of comorbidity and frailty in shaping the burden of atrial fibrillation: a multinational cross-sectional survey"],"prefix":"10.1038","volume":"16","author":[{"given":"Adele","family":"Ravelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Trevisan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 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She is a co-applicant on the AFFIRMO project on multimorbidity in AF (Grant Agreement No. 899871), ARISTOTELES project on artificial intelligence for management of chronic long-term conditions (Grant Agreement No. 101080189), and the TARGET project on digital twins for personalised management of atrial fibrillation and stroke (Grant Agreement No. 101136244), all of which are funded by the European Union Horizon Europe Research & Innovation programme. All other authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All procedures performed were in accordance with the ethical standards of the institutional and\/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethics Committees from the United Kingdom (REC 21\/YH\/0307), Italy (015534, ref. 5308\/AO\/22), Spain (2021\u201312-15-HCUVA), and Romania (2SNI\/13.01.2022). According to the guidelines of the Danish Research Ethics Committee, ethical approval was not required for Denmark. Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"10562"}}