{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:19:40Z","timestamp":1792268380534,"version":"4.4.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Clinical complexity (CC) in atrial fibrillation (AF) reflects overlapping risk factors that raise vulnerability to both thromboembolism and bleeding. Ethnic differences in the expression of CC remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We performed a post hoc analysis of the EORP-AF and APHRS-AF registries. CC was defined as a CHA\u2082DS\u2082\u2013VASc score \u22652 plus \u22651 of: (i) age \u226575 and BMI &amp;lt;23\u2005kg\/m\u00b2, (ii) chronic kidney disease, or (iii) prior major bleeding. Multivariable logistic regression identified predictors of CC, oral anticoagulant (OAC) use, and rhythm control. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndromes, and thromboembolic events. Secondary outcomes included each individual component and major bleeding. Associations were assessed using Cox regression models. Among 14 055 patients, 2794 (19.9%) met CC criteria (mean age 77 \u00b1 9 years; 46% female). Compared to Europeans, Asian patients with CC had a distinct clinical profile and were less likely to receive OAC (OR 0.75, 95% CI 0.57\u20131.01) or rhythm control (OR 0.53, 95% CI 0.41\u20130.69). CC was independently associated with increased risk of composite outcome (HR 1.55, 95% CI 1.35\u20131.77), all-cause death (HR 1.65, 95% CI 1.42\u20131.93), MACE (HR 1.50, 95% CI 1.26\u20131.80), cardiovascular death (HR 1.81, 95% CI 1.40\u20132.36), and major bleeding (HR 2.02, 95% CI 1.47\u20132.77). The excess risk of the composite outcome was greater in Asians (HR 2.28, 95% CI 1.57\u20133.32) than in Europeans (HR 1.51, 95% CI 1.31\u20131.75; P-interaction = 0.036).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among AF patients with CC, those enrolled in Asia exhibited marked differences in clinical profiles, management strategies, and outcomes, suggesting greater vulnerability to CC in the Asian population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euaf229","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T11:47:01Z","timestamp":1758196021000},"source":"Crossref","is-referenced-by-count":13,"title":["Clinical complexity in patients with atrial fibrillation: exploring differential risk profiles from European and Asian cohorts"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7119-1254","authenticated-orcid":false,"given":"Andrea Galeazzo","family":"Rigutini","sequence":"first","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool ,","place":["United Kingdom"]},{"name":"Internal, Vascular and Emergency Medicine\u2014Stroke Unit, University of Perugia , Perugia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2895-6234","authenticated-orcid":false,"given":"Tommaso","family":"Bucci","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool ,","place":["United 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Liverpool Heart & Chest Hospital , Liverpool ,","place":["United Kingdom"]},{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena , Modena ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2803-079X","authenticated-orcid":false,"given":"Amir","family":"Askarinejad","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool ,","place":["United Kingdom"]},{"name":"Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"vocabulary":"crossref","role":"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 at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool ,","place":["United Kingdom"]},{"name":"Department of Traslational and Precision Medicine, Sapienza University of Rome , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8343-4888","authenticated-orcid":false,"given":"Cecilia","family":"Becattini","sequence":"additional","affiliation":[{"name":"Internal, Vascular and Emergency Medicine\u2014Stroke Unit, University of Perugia , Perugia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9820-4815","authenticated-orcid":false,"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural 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