Evidence mapPaperPMID 41712451Full record

ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026

Cardiovascular-kidney-metabolic interplay in patients with atrial fibrillation receiving direct oral anticoagulants.

Yi-Hsin Chan, Yi-Wei Kao, Wen-Han Cheng, Shao-Wei Chen, Chung-Lieh Hung, Giulio Francesco Romiti, Gregory Y H Lip, Tze-Fan Chao

Abstract readMulticenter Study
In one paragraph

Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Article
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

8 authors.

Yi-Hsin ChanThe Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.ORCID 0000-0002-1406-8503
Yi-Wei KaoDepartment of Applied Statistics and Information Science, Ming Chuan University, Taoyuan City, Taiwan.ORCID 0000-0002-7891-9514
Wen-Han ChengDivision of Cardiology, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.ORCID 0000-0002-7629-0599
Shao-Wei ChenDivision of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.ORCID 0000-0003-1674-1295
Chung-Lieh HungDivision of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.ORCID 0000-0002-2858-3493
Giulio Francesco RomitiDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.ORCID 0000-0002-3788-8942
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.ORCID 0000-0002-7566-1626
Tze-Fan ChaoCardiovascular Center, Taipei Veterans General Hospital, Taipei City 112201, Taiwan.ORCID 0000-0002-6587-3094

Funding

Chang Gung Memorial HospitalMinistry of Science and Technology CMRPG3N1033Ministry of Science and Technology CMRPG3Q0721
6 · The paper itself

Abstract

aimsCardiovascular-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). METHODS AND

resultsWe included 17 378 AF patients (mean age 76.1 ± 10.7 years; 40.9% women) on DOACs from a multicentre Taiwanese database (2012-21). 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) 1.25-2.05], major bleeding (aHR 2.60, 95% CI 2.00-3.38), heart failure hospitalization (aHR 2.83, 95% CI 2.38-3.37), all-cause mortality (aHR 1.80, 95% CI 1.58-2.06), acute kidney injury (aHR 3.42, 95% CI 2.76-4.25), and major adverse renal events (aHR 20.84, 95% CI 14.14-30.71; all P < 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 (-10.29 vs. -4.67) and metabolic (-4.98 vs. -0.80) domains (P < 0.001).

conclusionIncreasing CKM burden was associated with progressively worse prognosis and shorter life expectancy in AF patients on DOACs, with more pronounced impacts in women.

Indexed as

Atrial FibrillationCardio-Renal SyndromeFactor Xa InhibitorsMetabolic SyndromeRenal Insufficiency, ChronicAdministration, OralAgedAged, 80 and overAnticoagulantsDatabases, FactualFemaleHumansMaleRisk AssessmentRisk FactorsTaiwanAnticoagulantsFactor Xa Inhibitorsatrial fibrillationCardio-kidney-metabolic syndromeCardiovascular diseaseChronic kidney diseaseDirect oral anticoagulant

Identifiers

PMID41712451
PMCPMC12978534

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.