{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:53:36Z","timestamp":1793717616474,"version":"4.6.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Multimorbidity is common among patients with atrial fibrillation (AF) and is associated with worse outcomes. We aimed to investigate the association between multimorbidity, AF progression and AF symptom severity in patients with paroxysmal AF.<\/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 RACE V (Reappraisal of AF: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilization in the Progression of AF) study included patients with paroxysmal AF and continuous rhythm monitoring. Multimorbidity was defined as \u22652 comorbidities (heart failure, hypertension, diabetes, coronary heart disease, kidney dysfunction, moderate or severe mitral valve regurgitation, or obesity). AF symptom severity was assessed via the University of Toronto AF Severity Scale questionnaire. The associations between multimorbidity, AF progression, and AF symptom severity were determined using logistic regression analyses. Median age was 65 (58\u201371)\u2009years and 179 of 417 patients (43%) were women, with a median of 1 (1\u20132) comorbidities. Median follow\u2010up was 2.2 (1.6\u20132.8) years. Multimorbidity was associated with AF progression (odds ratio [OR], 2.02 [95% CI, 1.10\u20133.72],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.024) and increased AF symptom severity (OR, 2.67 [95% CI, 1.79\u20133.99],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). There was a positive dose\u2013response relation between the number of comorbidities and AF progression (OR, 1.40 [95% CI, 1.09\u20131.79],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.008), as well as AF symptom severity (OR, 1.64 [95% CI, 1.35\u20131.99],\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). These results remained significant after adjusting for age.\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 paroxysmal AF, multimorbidity was associated with AF progression and AF symptom severity. The risk of AF progression and AF symptom severity increased with every additional comorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link>\n                      . Unique Identifier: NCT02726698.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.034514","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T06:02:34Z","timestamp":1740549754000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Multimorbidity Is Associated With Symptom Severity and Disease Progression in Patients with Paroxysmal Atrial Fibrillation\u2014Data From the RACE V Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5116-7378","authenticated-orcid":false,"given":"Colinda","family":"van Deutekom","sequence":"first","affiliation":[{"name":"University Medical Centre Groningen","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6003-5999","authenticated-orcid":false,"given":"Martijn E.","family":"van de Lande","sequence":"additional","affiliation":[{"name":"University Medical Centre Groningen","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7562-8650","authenticated-orcid":false,"given":"Rajiv","family":"Rama","sequence":"additional","affiliation":[{"name":"University Medical Centre Groningen","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6043-4172","authenticated-orcid":false,"given":"Bao\u2010Oanh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University Medical Centre Groningen","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Tieleman","sequence":"additional","affiliation":[{"name":"Martini Hospital","place":["Groningen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Webernd\u00f6rfer","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre+","place":["Maastricht, The Netherlands"]},{"name":"Maastricht University","place":["Maastricht, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2373-9858","authenticated-orcid":false,"given":"Martin E. W.","family":"Hemels","sequence":"additional","affiliation":[{"name":"Rijnstate Hospital","place":["Arnhem, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9223-4183","authenticated-orcid":false,"given":"Mirko","family":"de Melis","sequence":"additional","affiliation":[{"name":"Medtronic Bakken Research Centre","place":["Maastricht, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1532-3315","authenticated-orcid":false,"given":"Ulrich","family":"Schotten","sequence":"additional","affiliation":[{"name":"Maastricht University","place":["Maastricht, The Netherlands"]},{"name":"University of Maastricht","place":["Maastricht, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Linz","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre+","place":["Maastricht, The Netherlands"]},{"name":"Maastricht University","place":["Maastricht, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1073-5337","authenticated-orcid":false,"given":"Harry J. 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M.","family":"Crijns","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Centre+","place":["Maastricht, The Netherlands"]},{"name":"Maastricht University","place":["Maastricht, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7579-1201","authenticated-orcid":false,"given":"Isabelle C.","family":"van Gelder","sequence":"additional","affiliation":[{"name":"University Medical Centre Groningen","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2581-070X","authenticated-orcid":false,"given":"Michiel","family":"Rienstra","sequence":"additional","affiliation":[{"name":"University Medical Centre Groningen","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the RACE V Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.01.038"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4482"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux322"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-021-02120-3"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2020.03.038"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.012554"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euz339"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-020-02551-5"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eun369"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-041877"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2022-321027"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa123"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2002.122518"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.040"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.08.011"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvq357"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.107.754564"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-physiol-031720-085307"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.07.020"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-017-0604-9"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2020.11.015"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-020-1490-5"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euy311"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa424"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2022.08.021"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.034514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:39:00Z","timestamp":1788874740000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.034514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,3,4]]}},"alternative-id":["10.1161\/JAHA.123.034514"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.034514","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]},"assertion":[{"value":"2024-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e034514"}}