{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:21:41Z","timestamp":1792686101761,"version":"4.5.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001738","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["CMRPG3N1033"],"award-info":[{"award-number":["CMRPG3N1033"]}],"id":[{"id":"10.13039\/501100001738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001738","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["CMRPG3Q0721"],"award-info":[{"award-number":["CMRPG3Q0721"]}],"id":[{"id":"10.13039\/501100001738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardiovascular-kidney-metabolic (CKM) syndrome reflects the interplay of cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic risk factors. We examined whether the number, components, and complexity of CKM domains influence outcomes and years of life lost (YLL) per death in patients with non-valvular atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We included 17 378 AF patients (mean age 76.1 \u00b1 10.7 years; 40.9% women) on DOACs from a multicentre Taiwanese database (2012\u201321). Patients were followed until outcomes, death, or study end. Overall, 18.1, 35.1, 32.2, and 14.6% of patients had 0, 1, 2, and 3 CKM domains. Women more often exhibited kidney, metabolic, or combined domains. Clinical risks rose stepwise with domain number; patients with three domains had the highest risks of ischaemic stroke\/systemic embolic event\/acute coronary syndrome (IS\/SEE\/ACS) [adjusted hazard ratio (aHR) 1.60, 95% confidence interval (CI) 1.25\u20132.05], major bleeding (aHR 2.60, 95% CI 2.00\u20133.38), heart failure hospitalization (aHR 2.83, 95% CI 2.38\u20133.37), all-cause mortality (aHR 1.80, 95% CI 1.58\u20132.06), acute kidney injury (aHR 3.42, 95% CI 2.76\u20134.25), and major adverse renal events (aHR 20.84, 95% CI 14.14\u201330.71; all P &amp;lt; 0.001). Domain-specific analysis showed kidney involvement conferred the strongest risks (except IS\/SEE\/ACS), while cardiovascular and metabolic domains were more associated with IS\/SEE\/ACS. YLL rose with more CKM domains, with females associated with greater reductions, especially in cardiovascular (\u221210.29 vs. \u22124.67) and metabolic (\u22124.98 vs. \u22120.80) domains (P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increasing CKM burden was associated with progressively worse prognosis and shorter life expectancy in AF patients on DOACs, with more pronounced impacts in women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag028","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T12:45:35Z","timestamp":1771418735000},"source":"Crossref","is-referenced-by-count":7,"title":["Cardiovascular-kidney-metabolic interplay in patients with atrial fibrillation receiving direct oral 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,","place":["Taiwan"]},{"name":"Artificial Intelligence Development Center, Fu Jen Catholic University , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7629-0599","authenticated-orcid":false,"given":"Wen-Han","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital , Yilan ,","place":["Taiwan"]},{"name":"Cardiovascular Center, Taipei Veterans General Hospital , Taipei City 112201 ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University , Taipei City 112304 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1674-1295","authenticated-orcid":false,"given":"Shao-Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University , Taoyuan City ,","place":["Taiwan"]},{"name":"Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital , Taoyuan City ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2858-3493","authenticated-orcid":false,"given":"Chung-Lieh","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital , Taipei City ,","place":["Taiwan"]},{"name":"Institute of Biomedical Sciences, MacKay Medical College , New Taipei City ,","place":["Taiwan"]}],"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":"Department of Translational and Precision 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