Physical activity in patients with atrial fibrillation and adverse outcomes: results from a large-scale prospective multicenter European cohort

Introduction and objectives: Increased physical activity may improve outcomes in patients with atrial fibrillation (AF), but available data are limited. This study aimed to analyze the association between physical activity and major adverse outcomes in a large European AF cohort. Methods: We used data from a prospective, observational, large-scale multicenter study of AF in European patients, involving 27 countries and 250 centers. Patients self-reported their physical activity levels during the preceding 2 years, categorized as none (physically inactive), occasional, regular, or intense. The primary outcome was a composite of major adverse cardiovascular (CV) events and all-cause mortality. Results: A total of 9525 patients with AF were included (median age 71 years; 41% female). Overall, 43% reported being physically inactive. Among those who reported physical activity, 56.9% described it as occasional, 36.5% as regular, and 6.6% as intense. Inactive patients had a higher burden of both CV and non-CV comorbidities. Over a median follow-up of 728 days, 16.2% of the patients experienced the primary composite endpoint. Physical activity was independently associated with a lower risk of the primary endpoint (adjusted HR, 0.68; 95% CI, 0.59-0.76), with a progressively lower incidence as activity levels increased. Interaction analyses showed that the beneficial effect of physical activity was consistent among several subgroups, with no significant interactions. Conclusions: Physical activity, even at low levels, was associated with a reduced incidence of CV events and all-cause mortality. These benefits appear to be independent of CV risk factors and comorbidities, highlighting the importance of incorporating physical activity into holistic AF management strategies.