Ayodele Odutayo1, Christopher X Wong2, Allan J Hsiao3, Sally Hopewell4, Douglas G Altman4, Connor A Emdin5. 1. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ayodele.odutayo@bnc.ox.ac.uk. 2. Nuffield Department of Population Health, University of Oxford, Oxford, UK. 3. Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, USA. 4. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. 5. St John's College, University of Oxford, Oxford, UK.
Abstract
OBJECTIVE: To quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline and Embase. ELIGIBILITY CRITERIA: Cohort studies examining the association between atrial fibrillation and cardiovascular disease, renal disease, and death. Two reviewers independently extracted study characteristics and the relative risk of outcomes associated with atrial fibrillation: specifically, all cause mortality, cardiovascular mortality, major cardiovascular events, any stroke, ischaemic stroke, haemorrhagic stroke, ischaemic heart disease, sudden cardiac death, congestive heart failure, chronic kidney disease, and peripheral arterial disease. Estimates were pooled with inverse variance weighted random effects meta-analysis. RESULTS: 104 eligible cohort studies involving 9 686 513 participants (587 867 with atrial fibrillation) were identified. Atrial fibrillation was associated with an increased risk of all cause mortality (relative risk 1.46, 95% confidence interval 1.39 to 1.54), cardiovascular mortality (2.03, 1.79 to 2.30), major cardiovascular events (1.96, 1.53 to 2.51), stroke (2.42, 2.17 to 2.71), ischaemic stroke (2.33, 1.84 to 2.94), ischaemic heart disease (1.61, 1.38 to 1.87), sudden cardiac death (1.88, 1.36 to 2.60), heart failure (4.99, 3.04 to 8.22), chronic kidney disease (1.64, 1.41 to 1.91), and peripheral arterial disease (1.31, 1.19 to 1.45) but not haemorrhagic stroke (2.00, 0.67 to 5.96). Among the outcomes examined, the highest absolute risk increase was for heart failure. Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses. CONCLUSIONS: Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease. Interventions aimed at reducing outcomes beyond stroke are warranted in patients with atrial fibrillation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: To quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline and Embase. ELIGIBILITY CRITERIA: Cohort studies examining the association between atrial fibrillation and cardiovascular disease, renal disease, and death. Two reviewers independently extracted study characteristics and the relative risk of outcomes associated with atrial fibrillation: specifically, all cause mortality, cardiovascular mortality, major cardiovascular events, any stroke, ischaemic stroke, haemorrhagic stroke, ischaemic heart disease, sudden cardiac death, congestive heart failure, chronic kidney disease, and peripheral arterial disease. Estimates were pooled with inverse variance weighted random effects meta-analysis. RESULTS: 104 eligible cohort studies involving 9 686 513 participants (587 867 with atrial fibrillation) were identified. Atrial fibrillation was associated with an increased risk of all cause mortality (relative risk 1.46, 95% confidence interval 1.39 to 1.54), cardiovascular mortality (2.03, 1.79 to 2.30), major cardiovascular events (1.96, 1.53 to 2.51), stroke (2.42, 2.17 to 2.71), ischaemic stroke (2.33, 1.84 to 2.94), ischaemic heart disease (1.61, 1.38 to 1.87), sudden cardiac death (1.88, 1.36 to 2.60), heart failure (4.99, 3.04 to 8.22), chronic kidney disease (1.64, 1.41 to 1.91), and peripheral arterial disease (1.31, 1.19 to 1.45) but not haemorrhagic stroke (2.00, 0.67 to 5.96). Among the outcomes examined, the highest absolute risk increase was for heart failure. Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses. CONCLUSIONS:Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease. Interventions aimed at reducing outcomes beyond stroke are warranted in patients with atrial fibrillation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Mik Wetterslev; Nicolai Haase; Christian Hassager; Emilie P Belley-Cote; William F McIntyre; Youzhong An; Jiawei Shen; Alexandre Biasi Cavalcanti; Fernando G Zampieri; Helio Penna Guimaraes; Anders Granholm; Anders Perner; Morten Hylander Møller Journal: Intensive Care Med Date: 2019-05-14 Impact factor: 17.440
Authors: David F Briceño; Timothy M Markman; Florentino Lupercio; Jorge Romero; Jackson J Liang; Pedro A Villablanca; Edo Y Birati; Fermin C Garcia; Luigi Di Biase; Andrea Natale; Francis E Marchlinski; Pasquale Santangeli Journal: J Interv Card Electrophysiol Date: 2018-07-31 Impact factor: 1.900
Authors: Neal A Chatterjee; Claudia U Chae; Eunjung Kim; M Vinayaga Moorthy; David Conen; Roopinder K Sandhu; Nancy R Cook; I-Min Lee; Christine M Albert Journal: JACC Heart Fail Date: 2017-06-14 Impact factor: 12.035
Authors: Britney E Graham; Christian Darabos; Minjun Huang; Louis J Muglia; Jason H Moore; Scott M Williams Journal: Genet Epidemiol Date: 2017-09-25 Impact factor: 2.135
Authors: Per Wändell; Axel C Carlsson; Martin J Holzmann; Johan Ärnlöv; Jan Sundquist; Kristina Sundquist Journal: Ann Med Date: 2017-11-27 Impact factor: 4.709