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Abstract
Multimorbidity was highly prevalent in this middle-aged to older cohort of patients with AF. Importantly, those with multimorbidity are at increased risk of death over a follow-up period of 5 10 years. These findings suggest that such patients should be prioritized for interventions to optimize their management and in some cases to adjust their lifestyle to reduce the impact of their co-morbidities on survival. There may be a small number of multimorbid and frail patients with AF, likely to have poor life expectancy, who should be offered conservative and less invasive treatment options. However, it is possible that, in the past, patients with multimorbidity may have been denied effective treatments that might have improved their outcome, and we would suggest that in most cases effective treatments and interventions should not be withheld from these high-risk individuals. The problem of co-morbidity and multimorbidity needs to be given greater consideration in future AF guidelines