Evidence mapPaperPMID 41525015Full record

ArticleJournal of thrombosis and thrombolysis2026

Impact of biological age versus chronological age on clinical outcomes in patients with atrial fibrillation: insights from the COOL-AF registry.

Rungroj Krittayaphong, Pongsakorn Buraphat, Ahthit Yindeengam, Chulaluk Komoltri, Gregory Y H Lip

Abstract readMulticenter Study
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In one paragraph

Article in Journal of thrombosis and thrombolysis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Rungroj KrittayaphongDivision of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. rungroj.kri@mahidol.ac.th.
Pongsakorn BuraphatDivision of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Ahthit YindeengamHer Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Chulaluk KomoltriDepartment of Research Promotion, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Gregory Y H LipLiverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.

Funding

Health Systems Research Institute 59-053Heart Association of Thailand NA
6 · The paper itself

Abstract

Because patients with atrial fibrillation (AF) often exhibit heterogeneous risks that are not fully captured by traditional clinical factors, identifying a more accurate measure of physiological ageing could improve risk stratification and clinical management compared to chronological aging.This study aimed to determine the clinical outcome in relation to biological ageing in patients with AF. We used the data from the COOL-AF registry which is a multicentre nationwide registry of AF patients. The enrolment period was 2014-2017. Patients were followed-up for 3 years. Biological ageing was calculated from the Klemera-Doubal method (KDM) is a based on chronological age and blood chemistry and body function factors. The main outcome of this study was the composite of all-cause death, major bleeding, ischemic stroke/systemic embolism (SSE), and heart failure. We included total of 3405 patients, with a mean chronological age of 67.8 ± 11.3 years, and 1424 (41.8%) were female. During the median follow-up duration of 35.9 (IQR 34.8, 36.0) months, the composite outcomes, death, major bleeding, SSE, and heart failure developed in 726 (21.3%), 380 (11.2%), 199 (5.8%), 134 (3.9%), and 247 (7.3%) patients, respectively. Restricted cubic spline analysis showed that KDM bioage had higher hazard ratios compared to chronological age, with the adjusted Hazard ratios and 95% confidence interval (CI) of Quartile 4 (Q4) KDM for the composite outcomes, death, major bleeding, SSE, and heart failure were 2.11 (1.82-2.45), 2.53 (2.06-3.11), 2.12 (1.60-2.83), 1.96 (1.37-2.78), and 1.83 (1.42-2.38), respectively (all p < 0.001). In conclusion, KDM bioage is an independent predictor for clinical outcome and performs better than chronological age. These findings highlight the clinical value of incorporating biological ageing metrics into AF risk assessment models and suggest that KDM bioage may enhance personalized prognostication beyond conventional age-based evaluation.

Indexed as

AgingAtrial FibrillationAgedAge FactorsFemaleFollow-Up StudiesHeart FailureHemorrhageHumansMaleMiddle AgedRegistriesRisk AssessmentRisk FactorsAtrial fibrillationBioageChronological ageKlemera-Doubal method

Identifiers

PMID41525015

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.