Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis

Abstract

Objective: To summarize data on the prevalence/incidence, risk factors and prognosis of atrial fibrillation (AF) in patients with acute pulmonary embolism (aPE). Methods: MEDLINE, Embase, and Web of Science were searched to identify all published studies providing relevant data through December 12, 2021. Random-effects meta-analysis method was used to pool estimates. Results: We included 27 studies reporting data from a pooled population of 819,380 patients. The prevalence rates were 11.3% for pre-existing AF, 4.7% for newly diagnosed AF, and 13.2% for prevalent (total) AF. Pre- dictors of newly diagnosed AF (from one study) included congestive heart failure (adjusted odds ratio [aOR] 3.33, 95% CI: 1.81–6.12), ischemic heart disease (aOR 3.25, 95% CI: 1.65–6.39), massive PE (aOR 2.67, 95% CI: 1.19–5.99). Overall, AF was associated with increased risk of short-term (aOR 1.54, 95% CI: 1.44–1.64) and long- term mortality (aOR 1.58, 95% CI: 1.26–1.97). In subgroup analyses, all types of AF were associated with increased risk of short-term mortality: 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 1.50, 95% CI: 1.42–1.60). 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 also associated with higher long-term mortality. Conclusion: AF is present in about one in eight patients with aPE, and is associated with increased short- and long- term mortality. AF might improve risk stratification in patients with aPE.