Atrial fibrillation hurts survival in patients with acute pulmonary embolism

About one in eight patients with acute pulmonary embolism (aPE) has atrial fibrillation (AF), which contributes to increased short- and long-term mortality, a study has found.

Researchers conducted a systematic review of studies that reported the prevalence/incidence, risk factors, and prognosis of AF in patients with aPE. They searched multiple online databases and identified 27 studies for inclusion in the meta-analysis.

The studies included a total population of 819,380 aPE patients. Pooled data, obtained using the random-effects method, showed that the prevalence rates were 11.3 percent for pre-existing AF, 4.7 percent for newly diagnosed AF, and 13.2 percent for prevalent (total) AF.

Factors that predicted newly diagnosed AF (from one study) were congestive heart failure (adjusted odds ratio [aOR], 3.33, 95 percent confidence interval [CI], 1.81–6.12), ischaemic heart disease (aOR, 3.25, 95 percent CI, 1.65–6.39), and massive PE (aOR, 2.67, 95 percent CI, 1.19–5.99).

Overall, AF was associated with elevated risk of short-term (aOR, 1.54, 95 percent CI, 1.44–1.64) and long-term mortality (aOR, 1.58, 95 percent CI, 1.26–1.97).

Subgroup analyses showed that all types of AF were associated with increased risk of short-term mortality: pre-existing AF (aOR, 1.90, 95 percent CI, 1.59–2.27), newly diagnosed AF (aOR, 1.51, 95 percent CI, 1.18–1.93), and prevalent AF (aOR, 1.50, 95 percent CI, 1.42–1.60). Of note, pre-existing AF (aOR, 2.08, 95 percent CI, 1.27–3.42) and prevalent AF (aOR, 1.29, 95 percent CI, 1.02–1.63) also increased the risk of long-term mortality.