Atrial fibrillation in acute PE common, associated with increased mortality
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A new analysis in Respiratory Medicine found that about one in eight patients with acute pulmonary embolism also have atrial fibrillation, which was associated with increased short- and long-term mortality.
“Studies investigating the prognostic impact of AF in patients with acute PE have shown conflicting results,” Jean Jacques Noubiap, MD, from the Centre for Heart Rhythm Disorders at the University of Adelaide in Australia, and colleagues wrote. “Indeed, whether AF truly increases the risk of death in patients with acute PE or is just a marker of comorbidity or acute PE severity remain uncertain.”
Researchers searched MEDLINE, Embase and Web of Science and identified 27 published studies with data on prevalence, risk factors and prognosis of AF in patients with acute PE through December 2021. The studies had a pooled population of 819,380 patients and most were conducted in Europe (59.3%) and had low (63%) or moderate (25.9%) bias risk.
According to results, the prevalence of pre-existing and newly diagnosed AF was 11.3% and 4.7%, respectively, and total prevalence of AF was 13.2%.
Congestive heart failure (adjusted OR = 3.33; 95% CI, 1.81-6.12), ischemic heart disease (aOR = 3.25; 95% CI, 1.65-6.39) and massive PE (aOR = 2.67; 95% CI, 1.19-5.99) were identified as predictors of newly diagnosed AF.
Researchers also reported that AF was associated with increased risk for short-term (aOR = 1.54; 95% CI, 1.44-1.64) and long-term (aOR = 1.58; 95% CI, 1.26-1.97) mortality, with pre-existing AF (aOR = 1.90; 95% CI, 1.59-2.27), newly diagnosed AF (aOR = 1.51; 95% CI, 1.18-1.93) and prevalent AF (aOR = 1.5; 95% CI, 1.42-1.6) associated with an increased risk for short-term mortality, according to subgroup analyses. However, only pre-existing AF (aOR = 2.08; 95% CI, 1.27-3.42) and prevalent AF (aOR = 1.29; 95% CI, 1.02-1.63) were associated with higher long-term mortality.
“Studies are needed to determine the appropriate rhythm monitoring strategies in patients with acute PE,” the researchers wrote. “In view of the strong prognostic value of AF, its incorporation into risk stratification schemes for patients with acute PE should be considered.”