The Canadian Journal of Cardiology · Jan 15, 2026

Atrial Fibrillation and Transitions Across Functional States in Older Adults: A Longitudinal Multistate Model Analysis

By Noale M, Ceolin C, Petrovic M et al.

BACKGROUND: Atrial fibrillation (AF) is prevalent in older adults and has been associated with functional decline beyond its cardiovascular complications. However, the interplay between AF, multimorbidity, and functional decline remains poorly understood. In this study we investigated the effect of AF and multimorbidity on longitudinal transitions in functional status among older adults, considering initial self-sufficiency levels. METHODS: This longitudinal analysis included 3083 community-dwelling individuals aged 65 years or older from the Progetto Veneto Anziani (Pro.V.A.) study. Functional status was classified into 3 states-independent, moderately impaired, and severely impaired in activities of daily living-and modelled through continuous-time multistate models. Independent variables included AF, multimorbidity, and covariates such as age, sex, education, living arrangements, smoking status, body mass index, Mini-Mental State Examination and Geriatric Depression Scale scores. RESULTS: Over a median follow-up of 4.4 years (standard deviation, 0.5), 33.5% of independent individuals experienced functional decline, 13% died, and only 12.2% improved after moderate impairment. AF was significantly associated with transition from independence to severe functional impairment (hazard ratio [HR], 4.12; 95% confidence interval [CI], 1.83-9.24), although this estimate is on the basis of a small number of events and should be interpreted with caution, from moderate to severe impairment (HR, 1.75; 95% CI, 1.01-3.1), and with mortality in moderately impaired individuals (HR, 1.66; 95% CI, 1.16-2.38). Multimorbidity showed no association with worsening transitions but was associated with mortality among independent individuals (HR, 1.15; 95% CI, 1.07-1.24). CONCLUSIONS: AF is a marker of greater risk of severe functional decline in older adults, whereas multimorbidity primarily increases mortality. Routine functional assessments and person-centred interventions are essential to preserve autonomy and prevent disability in older adults with AF.

doi.org/10.1016/j.cjca.2025.12.044Open accessPubMed 41544762Populations