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

## TL;DR

Liver disease in patients with atrial fibrillation is linked to lower use of blood thinners and higher risks of bad outcomes, especially in Europe.

## Contribution

The study reveals regional differences in anticoagulant prescription and outcomes for AF patients with liver disease in Europe and Asia.

## Key findings

- Liver disease was associated with reduced oral anticoagulant prescription, especially in European patients.
- Patients with liver disease had higher risks of mortality and cardiovascular events, particularly if not prescribed anticoagulants.
- No significant differences in adverse outcomes were found between European and Asian patients with liver disease.

## Abstract

In patients with atrial fibrillation (AF), the impact of liver disease (LD) on oral anticoagulant (OAC) prescription and outcomes remains unclear, as well as possible differences between European and Asian populations.

To examine the impact of LD on OAC prescriptions and risks of adverse outcomes in a large cohort of European and Asian AF patients.

AF patients were derived from two large observational registries held in Europe and Asia. OAC prescription and risk of outcomes were analysed according to LD at baseline. The primary outcome was the composite of all‐cause death and major adverse cardiovascular events (MACEs). Logistic regression assessed associations with OAC prescription, and Cox regression analyses evaluated risks of outcomes. Interaction analyses were performed between European and Asian patients.

Among 15,681 patients (mean age 68.4 ± 10.7 years; 37.1% female), 517 (3.3%) had LD. The OAC prescription rate was similar among European and Asian individuals (6.8% vs. 82.9%, p = .113). After adjustments, LD was associated with lower OAC prescription (OR .67, 95% CI .53–.84), with a greater reduction in European than in Asian patients (p
int = .015). LD was associated with a higher risk of the composite outcome (HR 1.42, 95% CI 1.11–1.81) and MACEs (HR 1.47, 95% CI 1.07–2.02), with no significant European versus Asian differences (p
int = .631). Among LD patients, those not prescribed OAC had a higher MACE risk compared with those prescribed OAC (p
int = .050), with no differences in major bleeding.

In AF, LD is associated with reduced OAC prescription, especially in Europe, and a higher risk of adverse outcomes, particularly in patients not receiving OAC, with no significant differences between European and Asian cohorts.

In this large European–Asian cohort of patients with atrial fibrillation, liver disease was linked to lower oral anticoagulant use—particularly in Europe—and to higher risks of mortality and cardiovascular events. These findings highlight the adverse impact of liver disease, especially when oral anticoagulation is withheld.