#AI reads Urine# Association of Albuminuria With 1-Year Risk of Heart Failure and Other Adverse Outcomes in Atrial Fibrillation
Published 11 September, 2025
This study, published in the *Journal of the American Heart Association*, is a retrospective cohort study of adults aged ≥66 years with newly diagnosed atrial fibrillation (AF) in Ontario, Canada, aiming to explore the association between albuminuria and 1-year risks of heart failure (HF) and other adverse outcomes in AF patients. Using linked administrative databases, albuminuria was assessed via two methods: urine albumin-to-creatinine ratio (UACR) and dipstick proteinuria (categorized as negative, trace, 1+, 2+, ≥3+). Cause-specific hazard regression was used to estimate adjusted hazard ratios (HRs) for four adverse outcomes: HF hospitalizations or emergency department visits, stroke hospitalizations, bleeding hospitalizations, and death.
A total of 64,717 participants with UACR data and 110,430 with dipstick proteinuria data were included. Compared with a UACR of 5 mg/g, a UACR of 30 mg/g (below the microalbuminuria threshold) was associated with HRs of 1.39 (95% CI: 1.28–1.50) for HF, 1.22 (95% CI: 1.07–1.40) for bleeding, and 1.35 (95% CI: 1.27–1.42) for death. For stroke, the HR for a UACR of 30 mg/g versus 5 mg/g was 1.16 (95% CI: 0.99–1.36), but significantly elevated HRs were observed when UACR ≥65 mg/g. Additionally, higher degrees of dipstick proteinuria were associated with increased HRs for adverse outcomes. The HF risk associated with a UACR of 30 mg/g (versus 5 mg/g) was higher than that of all CHA₂DS₂-VASC score components except for age >75 years and prior HF.
The study concludes that albuminuria is associated with increased risks of HF, stroke, bleeding, and death in AF patients, even at low UACR levels, and may improve risk stratification for AF patients beyond traditional scoring systems. Clinically, screening for albuminuria at the time of AF diagnosis may help identify high-risk individuals who could benefit from closer follow-up or initiation of cardioprotective therapies (e.g., renin-angiotensin system blockers). Incorporating UACR into AF management may also enhance prediction models for HF and bleeding.
J Am Heart Assoc. 2025 Aug 29:e041185. doi: 10.1161/JAHA.125.041185.
Youhe Gao
Statement: During the preparation of this work the author(s) used Doubao / AI reading for summarizing the content. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the published article.
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