As atrial fibrillation (AF) becomes more prevalent worldwide, researchers examining multimorbidity, frailty, and polypharmacy in patients with AF across Asia and Europe report that all three are linked to worse outcomes, “leading to clinically complex patient phenotypes.”
In a study recently published in GeroScience, European patients exhibited greater clinical complexity than Asian patients. In the Asian cohort, frailty was associated with lower prescribing of oral anticoagulants (OACs) and poorer outcomes — differences that may help explain variations in survival rates and care.
Global Clinical Complexity
The research team analyzed data from 15,762 patients enrolled in two large prospective AF registries: the EURObservational Research Programme Atrial Fibrillation General Long-Term Registry — covering 27 European countries — and the Asia-Pacific Heart Rhythm Society AF Registry — covering five Asian countries. Both registries used the same case report form, making the comparison reliable.
Patients were assessed for multimorbidity — having two or more chronic conditions — and frailty was assessed using the frailty index (FI), with frailty defined as an FI ≥ 0.25 and polypharmacy, consuming five or more medications.
The data revealed notable differences: 79.5% vs 70.2% of European vs Asian patients with AF had multimorbidity. Frailty was common in 17.9% vs 10.5% of Europeans vs Asians; 55.7% vs 33.1% of Europeans vs Asians met the definition of polypharmacy.
The two cohorts also showed different spectrums of comorbidity profiles. European patients had higher prevalences of coronary artery disease, heart failure, peripheral artery disease, and chronic kidney disease, while Asian patients had higher prevalences of hypertension, diabetes mellitus, dyslipidemia, anemia, cancer, and prior thromboembolic or bleeding events.
Regarding the primary outcome, a composite of all-cause death and major adverse cardiovascular events, frailty affected Asian patients more than European patients, increasing their risk for adverse events.
Moreover, “in the overall cohort, multimorbidity and polypharmacy were associated with higher odds of OAC prescription at baseline, while frailty was associated with lower odds of prescription,” the authors explained. In particular, frail Asian patients received OACs far less frequently than frail Europeans, with an odds ratio of 0.34 vs 0.47. The difference reflects several factors, including high out-of-pocket costs, a higher rate of intracranial hemorrhage among Asians, and concerns about side effects.
Europe’s AF surge
AF prevalence is age-dependent and rises with population aging; it affects approximately 1%-3% of adults and more than 15% of those aged 80 years or older. In Italy, the Progetto FAI (Atrial Fibrillation in Italy) survey estimated a 7.3% prevalence among individuals aged 65 years or older — more than 1 million older adults with AF in 2016. That number is projected to increase by about 75% by 2060, reaching roughly 2 million.
These estimates come from an Italian primary care cohort, and — as is typical — most epidemiologic data to date are from Western settings. Real-world comparisons of European and Asian cohorts, however, highlight organizational and cultural drivers of care disparities — insights that matter for Italy’s increasingly diverse patient population.
Benedetta Pagni December 30, 2025. https://www.medscape.com/
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