Evidence mapPaperPMID 41999342Full record

ArticleEuropean journal of clinical investigation2026

Impact of Anaemia on Management and Outcomes in Patients With Atrial Fibrillation: Insights From European and Asian Cohorts.

Andrea Galeazzo Rigutini, Tommaso Bucci, Amir Askarinejad, Enrico Tartaglia, Michele Rossi, Cecilia Becattini, Giuseppe Boriani, Hung-Fat Tse, Tze-Fan Chao, Gregory Y H Lip

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Article in European journal of clinical investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Andrea Galeazzo RigutiniLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.ORCID https://orcid.org/0009-0003-7119-1254
Tommaso BucciLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.ORCID https://orcid.org/0000-0003-2895-6234
Amir AskarinejadLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.ORCID https://orcid.org/0000-0003-2803-079X
Enrico TartagliaLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Michele RossiLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Cecilia BecattiniInternal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Giuseppe BorianiCardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Hung-Fat TseThe University of Hong Kong, Hong Kong Special Administrative Region of China, Pok Fu Lam, Hong Kong.ORCID https://orcid.org/0000-0003-4665-7887
Tze-Fan ChaoDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.ORCID https://orcid.org/0000-0002-6587-3094
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.ORCID https://orcid.org/0000-0002-7566-1626

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnaemia is a common comorbidity in patients with atrial fibrillation (AF) receiving oral anticoagulants (OACs). While its relationship with bleeding is well established, the prothrombotic role and ethnic variations remain unclear.

methodsWe analysed two large prospective AF registries from Europe (EORP-AF) and East Asia (APHRS-AF). Patients were classified by anaemia status at enrolment. Logistic regression assessed clinical correlates and treatment patterns, while multivariable Cox models and propensity score matching (PSM) evaluated outcomes. Restricted cubic spline analyses explored the haemoglobin-risk relationship across ethnic groups. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE); secondary outcomes included individual components and major bleeding (MB).

resultsAmong 10,857 patients with AF (mean age 69 ± 11 years, 40.0% women), 3372 (31.0%) had anaemia, which clustered with multimorbidity and frailty. Anaemic patients were less likely to receive OACs (OR 0.67, 95% CI 0.58-0.78) and rhythm-control (OR 0.91, 95% CI 0.81-1.02). Anaemia was independently associated with higher risk of the composite outcome (HR 1.54, 95% CI 1.34-1.78), all-cause death (HR 1.81, 95% CI 1.51-2.15), MACE (HR 1.39, 95% CI 1.16-1.66), CV death (HR 1.90, 95% CI 1.43-2.54) and MB (HR 1.79, 95% CI 1.31-2.46) consistent also after PSM. Risk increased progressively with anaemia severity, particularly below 10 g/dL. Associations were consistent across Asian and European cohorts.

conclusionAnaemia identifies a vulnerable AF phenotype associated with excess mortality, adverse cardiovascular outcomes and increased bleeding risk, which remains frequently undertreated. Risk rises with anaemia severity, and although biological effects appear consistent across ethnicities, treatment disparities persist. Anaemia should refine, not restrict, therapy within integrated AF care.

Indexed as

AnemiaAnticoagulantsAtrial FibrillationAgedAsia, EasternCause of DeathEuropeFemaleHemorrhageHumansLogistic ModelsMaleMiddle AgedPropensity ScoreProportional Hazards ModelsProspective StudiesAnticoagulants

Identifiers

PMID41999342
PMCPMC13091571

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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.