More focus needed on non-stroke events in AF
medwireNews: Atrial fibrillation (AF) is associated with an increased risk of a wide range of adverse outcomes including death and cardiovascular and renal disease, results of a systematic review and meta-analysis involving more than 9 million individuals show.
The relative and absolute risk associated with many of these conditions was greater than that of stroke, which is a known risk of AF, prompting Ayodele Odutayo (University of Oxford, UK) and co-researchers to call for interventions to reduce the risk of non-stroke outcomes in adults with AF.
The team reviewed 104 cohort studies that examined AF and associated outcomes in 9,686,513 participants (587,867 with AF).
The highest risk increase was for congestive heart failure, where patients with AF experienced 11.1 more events per 1000 participant–years than those without and had a significant 4.99-fold increased relative risk (RR).
This compares with a 2.42-fold RR, or 3.6 events 1000 participant–years, for stroke. The risk of ischaemic stroke was also significantly higher among the AF patients, at a RR of 2.33, but there was no significant association with haemorrhagic stroke, the authors report in The BMJ.
The patients with AF had 1.46- and 2.03-fold increased RRs of all-cause and cardiovascular mortality, respectively, with corresponding absolute risk increases of 3.8 and 2.6 events per 1000 participant–years.
For chronic kidney disease, AF was associated with an absolute risk increase of 6.6 events per 1000 participant–years, and a 1.64-fold increased RR.
Risk of ischaemic heart disease and sudden cardiac death were also significantly higher among the patients with AF, at RRs of 1.61 and 1.88, respectively, and corresponding absolute risk increases of 1.4 and 0.6 events per 1000 participant–years.
Further analyses showed that the associations between AF and each of the outcomes were “broadly consistent” in subgroups stratified by age, the presence of cardiovascular disease and baseline risk, as well as in sensitivity analyses of study characteristics.
Odutayo et al conclude: ”Even though the associations we describe cannot indicate causality for the non-stroke outcomes, there is merit in developing clinical risk prediction models for outcomes such as congestive heart failure; particularly given our relative and absolute risk estimates.”
They add that their findings “could have implications for the prioritisation of public health resources and the development of novel interventions for adults with atrial fibrillation.”
By Laura Cowen
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