Atrial Fibrillation in Acute Pulmonary Embolism: Prevalence and Prognosis

According to a report in the Respiratory Medicine, atrial fibrillation, including newly diagnosed atrial fibrillation, was seen in approximately one in eight patients with acute pulmonary embolism (aPE), and was associated with increased short- and long-term mortality. The study’s lead author, Jean Jacques Noubiap, noted the presence of atrial fibrillation in aPE increased mortality, “irrespective of its temporal pattern.”

This study was a meta-analysis designed to describe the overall prevalence/incidence, risk factors, and prognosis for atrial fibrillation in aPE, based on previously published data. The Medline, Embase, and Web of Science databases were searched for relevant studies, and pooled data estimates were calculated with random-effects models.

Atrial Fibrillation in Acute Pulmonary Embolism Analysis Data

Among 27 included studies with 819,380 pooled patients, the prevalence rates for pre-existing atrial fibrillation, newly diagnosed atrial fibrillation, and total (prevalent) atrial fibrillation were 11.3%, 4.7%, and 13.2%. One study noted newly diagnosed atrial fibrillation had predictive factors including 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), and massive PE (aOR 2.67; 95% CI, 1.19-5.99). Overall, atrial fibrillation was associated with increased 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, pre-existing (aOR 1.90; 95% CI, 1.59-2.27), newly diagnosed (aOR 1.51; 95% CI, 1.18-1.93), and prevalent atrial fibrillation (aOR 1.50; 95% CI, 1.42-1.60) were associated with increased risk of short-term mortality. Comparatively, only pre-existing (aOR 2.08, 95% CI: 1.27–3.42) and prevalent atrial fibrillation (aOR 1.29; 95% CI: 1.02-1.63) were also associated with higher long-term mortality.

Ultimately, the study’s authors calculated a prevalence of one in eight for atrial fibrillation in aPE, and proposed that, “Considering its strong prognostic impact, atrial fibrillation might be incorporated into risk stratification schemes for patients with aPE.”

Find more recent studies on the Atrial Fibrillation Knowledge Hub