Liver disease in management and outcomes of European and Asian patients with atrial fibrillation: A report from two observational prospective registries.

Liver disease was present in 3.3% of AF patients across European and Asian registries.

• Total cohort comprised 15,681 patients with a mean age of 68.4 ± 10.7 years and 37.1% female.
• 517 patients (3.3%) had liver disease at baseline.
• Patients were derived from two large observational prospective registries held in Europe and Asia.

Liver disease was associated with lower OAC prescription after adjustment.

• Adjusted OR for OAC prescription in patients with liver disease was 0.67 (95% CI 0.53–0.84).
• The reduction in OAC prescription associated with liver disease was greater in European than in Asian patients (pint = .015).
• Overall OAC prescription rate did not differ significantly between European and Asian patients with liver disease (6.8% vs. 82.9%, p = .113).

Liver disease was associated with a higher risk of the composite outcome of all-cause death and major adverse cardiovascular events (MACEs).

• HR for the composite outcome (all-cause death and MACEs) was 1.42 (95% CI 1.11–1.81).
• HR for MACEs specifically was 1.47 (95% CI 1.07–2.02).
• There were no significant differences in these outcome risks between European and Asian patients (pint = .631).
• Cox regression analyses were used to evaluate risks of outcomes.

Among patients with liver disease, those not prescribed OAC had a higher MACE risk compared with those prescribed OAC.

• The interaction for MACE risk between OAC prescription status and liver disease was statistically significant (pint = .050).
• There were no significant differences in major bleeding between liver disease patients prescribed versus not prescribed OAC.
• This finding suggests a potential benefit of OAC in AF patients with liver disease despite common clinical hesitancy to prescribe it.

The overall OAC prescription rate differed markedly between European and Asian AF patients.

• OAC prescription rates were 6.8% in European and 82.9% in Asian patients with liver disease (p = .113 for interaction with liver disease status).
• Despite this large absolute difference in prescription rates, the interaction p-value indicates this difference was not significantly modified by liver disease status.
• Logistic regression was used to assess associations with OAC prescription.