{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:01:17Z","timestamp":1793221277224,"version":"4.5.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,10,17]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Clinical risk factors are common among patients with atrial fibrillation (AF), but there are still limited data on their association with oral anticoagulant (OAC) treatment patterns and major outcomes. We aim to analyze the association between clinical risk phenotypes on AF treatment patterns and the risk of major outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The GLORIA\u2010AF (Global Registry on Long\u2010Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation) phase 2 and 3 registries enrolled patients with a recent diagnosis of AF between 2011 and 2016. We defined 4 features of clinical risk among patients with CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc \u22652: elderly individuals (aged \u226580\u2009years), chronic kidney disease (estimated glomerular filtration rate &lt;45\u2009mL\/min), history of stroke, and history of bleeding. We analyzed the odds of receiving OAC and the risk of OAC discontinuation and adverse events at follow\u2010up according to specific combinations and cumulative burden of these features. Primary outcome was the composite of all\u2010cause death, thromboembolism, and major bleeding. Among 28\u2009891 (mean\u00b1SD age, 70.1\u00b110.5\u2009years; 45.5% women) patients included, 10\u2009797 (37.3%) had at least 1 clinical risk feature. OAC use was lower among patients in the elderly group (odds ratio [OR], 0.85 [95% CI, 0.75\u20130.96]), those with history of both stroke and bleeding (OR, 0.45 [95% CI, 0.35\u20130.56]), and those with multiple features (OR, 0.71 [95% CI, 0.62\u20130.82]). Increasing burden of clinical risk features was associated with OAC discontinuation, with highest magnitude in those with \u22653 features (hazard ratio [HR], 1.68 [95% CI, 1.31\u20132.15]). Groups with increasingly complex clinical risk phenotypes were associated with the occurrence of the primary composite outcome, with the highest figures observed for groups with a history of both stroke and bleeding (adjusted HR, 2.36 [95% CI, 1.83\u20133.04]) and multiple features (adjusted HR, 2.86 [95% CI, 2.52\u20133.25]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In patients with AF, clinical risk phenotypes are multifaceted and heterogenous, and they are associated with differences in stroke prevention and worse prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.030565","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T07:23:15Z","timestamp":1696922595000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Implications of Clinical Risk Phenotypes on the Management and Natural History of Atrial Fibrillation: A Report From the GLORIA\u2010AF"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3788-8942","authenticated-orcid":false,"given":"Giulio Francesco","family":"Romiti","sequence":"first","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital Liverpool United Kingdom"},{"name":"Department of Translational and Precision Medicine Sapienza\u2013University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1452-2478","authenticated-orcid":false,"given":"Marco","family":"Proietti","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health University of Milan Milan Italy"},{"name":"Division of Subacute Care IRCCS Istituti Clinici Scientifici Maugeri Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9460-4435","authenticated-orcid":false,"given":"Bernadette","family":"Corica","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital Liverpool United Kingdom"},{"name":"Department of Translational and Precision Medicine Sapienza\u2013University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2766-5286","authenticated-orcid":false,"given":"Niccol\u00f2","family":"Bonini","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital Liverpool United Kingdom"},{"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"}]},{"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 Sciences University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1423-5348","authenticated-orcid":false,"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. 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