{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T04:22:06Z","timestamp":1776572526208,"version":"3.51.2"},"reference-count":45,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Clinical associations and prognosis of patients with symptom\u2010controlled AF (scAF) remain poorly understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed data from the Asian\u2010Pacific Heart Rhythm Society and EURObservational Research Programme registries. Based on the European Heart Rhythm Association (EHRA) score, patients were classified as scAF (EHRA I or II) or symptomatic AF (EHRA III or IV). Clinical characteristics were examined by logistic regression, and prognosis was assessed by Cox models. The primary outcome was composed of all\u2010cause death and major cardiovascular events. Interaction analyses were performed to investigate ethnic differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 13,577 AF patients (mean age 69.0\u2009\u00b1\u200911.6\u2009years; 38.7% female), 11,470 (84.5%) had scAF. Asians were more likely to be scAF, characterised by younger age and lower cardiovascular burden compared to Europeans. Diabetes mellitus was significantly associated with scAF only in Asians (adjusted odd ratio [aOR] 1.43, 95% confidence interval [CI] 1.03\u20132.04, <jats:italic>p<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.021). The associations with hypertension (aOR 1.29, 95% CI 0.98\u20131.70, <jats:italic>p<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.004) and prior ischemic stroke (aOR 1.75, 95% CI 0.96\u20133.58, <jats:italic>p<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.045) were more evident in Asians.<\/jats:p><jats:p>Patients with scAF showed a notable association with increased likelihood of using vitamin K antagonists (aOR 1.19, 95% CI 1.07\u20131.33), which was more prominent in Asians. In both Asians and Europeans, scAF was associated with reduced rhythm control management. Compared to non\u2010scAF, European patients with scAF had a reduced risk of the composite outcome, but the association was non\u2010significant in Asians (<jats:italic>p<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.594).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Asians and Europeans with scAF demonstrate clinically relevant differences in terms of overall prevalence, related risk factors, and clinical management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.70086","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T09:48:44Z","timestamp":1749462524000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical associations and prognosis in Asian and European patients with symptom\u2010controlled atrial fibrillation: Insights from two prospective registries in Europe and Asia"],"prefix":"10.1111","volume":"55","author":[{"given":"Wee Siong","family":"Teo","sequence":"first","affiliation":[{"name":"Department of Cardiology National Heart Centre  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5073-1798","authenticated-orcid":false,"given":"Manlin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Cardiology Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Bucci","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-0995","authenticated-orcid":false,"given":"Steven Ho Man","family":"Lam","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Sha Tin New Territories Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Cardiovascular Medicine The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University  Nanchang Jiangxi China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2808-6286","authenticated-orcid":false,"given":"Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Cardiovascular and Metabolic Medicine Institute of Life Course and Medical Sciences, University of Liverpool  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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 Science Italy University of Modena and Reggio Emilia, Policlinico di Modena  Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hung\u2010Fat","family":"Tse","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, School of Clinical Medicine Queen Mary Hospital, The University of Hong Kong  Hong Kong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6587-3094","authenticated-orcid":false,"given":"Tze\u2010Fan","family":"Chao","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine and Cardiovascular Research Centre, National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Division of Cardiology, Department of Medicine Taipei Veterans General Hospital  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory Y. 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