{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:43:23Z","timestamp":1792658603457,"version":"4.5.0"},"reference-count":46,"publisher":"Georg Thieme Verlag KG","issue":"12","funder":[{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim GmbH","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>Background\u2003Clinical complexity is common in atrial fibrillation (AF) patients. We assessed the impact of clinical complexity on oral anticoagulant (OAC) treatment patterns and major adverse outcomes in a contemporary cohort of AF patients.<\/jats:p>\n                  <jats:p>Methods\u2003The GLORIA-AF Phase II and III Registry enrolled newly diagnosed AF patients with at least one stroke risk factor. Among patients with CHA2DS2-VASc score \u22652, we defined four domains of perceived clinical complexity: frail elderly (age \u226575 years and body mass index &lt;23\u2009kg\/m2), chronic kidney disease (CKD, creatinine clearance &lt;60\u2009mL\/min), history of bleeding, and those with \u22652 of the above conditions. We evaluated the associations between clinical complexity domains and antithrombotic treatment prescription, risk of OAC discontinuation, and major adverse outcomes.<\/jats:p>\n                  <jats:p>Results\u2003Among the 29,625 patients included (mean age 69.6\u2009\u00b1\u200910.7 years, 44.2% females), 9,504 (32.1%) presented with at least one complexity criterion. Clinical complexity was associated with lower OAC prescription, with stronger associations in frail elderly (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.36\u20130.62) and those with \u22652 complexity domains (OR: 0.50, 95% CI: 0.44\u20130.57). Risk of OAC discontinuation was higher among frail elderly (hazard ratio [HR]: 1.30, 95% CI: 1.00\u20131.69), CKD (HR: 1.10, 95% CI: 1.02\u20131.20), and those with \u22652 complexity domains (HR: 1.39, 95% CI: 1.23\u20131.57). Clinical complexity was associated with higher risk of the primary outcome of all-cause death, thromboembolism, and major bleeding, with the highest magnitude in those with \u22652 criteria (HR: 1.63, 95% CI: 1.43\u20131.86).<\/jats:p>\n                  <jats:p>Conclusion\u2003In AF patients, clinical complexity influences OAC treatment management, and increases the risk of poor clinical outcomes. These patients require additional efforts, such as integrated care approach, to improve their management and prognosis.<\/jats:p>","DOI":"10.1055\/s-0042-1756355","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T19:02:10Z","timestamp":1661799730000},"page":"2030-2041","source":"Crossref","is-referenced-by-count":120,"title":["Clinical Complexity Domains, Anticoagulation, and Outcomes in Patients with Atrial Fibrillation: A Report from the GLORIA-AF Registry Phase II and III"],"prefix":"10.1055","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3788-8942","authenticated-orcid":false,"given":"Giulio Francesco","family":"Romiti","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom"},{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Proietti","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy"},{"name":"Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy"},{"name":"Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Bonini","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy"},{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wern Yew","family":"Ding","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menno V.","family":"Huisman","sequence":"additional","affiliation":[{"name":"Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands"}],"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":[{"name":"Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the GLORIA-AF Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,8,29]]},"reference":[{"issue":"35","key":"ref1","doi-asserted-by":"crossref","first-page":"2746","DOI":"10.1093\/eurheartj\/eht280","article-title":"Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060","volume":"34","author":"B P Krijthe","year":"2013","journal-title":"Eur Heart 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Piccini","year":"2022","journal-title":"Lancet"},{"issue":"03","key":"ref40","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0040-1716408","article-title":"The 4S-AF scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): a novel approach to in-depth characterization (rather than classification) of atrial fibrillation","volume":"121","author":"T S Potpara","year":"2021","journal-title":"Thromb Haemost"},{"issue":"11","key":"ref41","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":"G YH Lip","year":"2017","journal-title":"Nat Rev Cardiol"},{"issue":"11","key":"ref42","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/j.amjmed.2018.06.012","article-title":"Improved outcomes by integrated care of anticoagulated patients with atrial fibrillation using the simple ABC (Atrial Fibrillation Better Care) 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