AF may signal pulmonary embolism in patients with chest pain
MedWire News: Study findings suggest that having atrial fibrillation (AF) does not increase the likelihood for a pulmonary embolism (PE) diagnosis, except in patients presenting with chest pain.
Pulmonary embolism may be a trigger for AF, but some data imply that AF may conversely be a risk factor for PE. Previous studies of patients with PE and no other cardiopulmonary disease have found few cases of AF.
Gregoire Gex (Geneva University Hospital, Switzerland) and colleagues conducted an analysis to determine if the presence of AF increased the pre-test probability of PE and whether there is a link between PE and AF. They reviewed data, including for initial electrocardiograms, from two trials of 2449 patients admitted to hospital with suspected PE.
As reported in the Journal of Thrombosis and Haemostasis, 133 (5.5%) patients were found to have AF. Of these, 19% had PE compared with 23% of those without AF, a difference that was nonsignificant.
This lack of association between AF and PE was consistent throughout all subgroups of patients known to have lower general rates of AF.
However, patients with AF who also had dyspnea as one of their symptoms had a much lower probability of PE, whereas the opposite was true in those with AF and chest pain alone.
Therefore, the investigators noted that "while AF does not influence the probability of PE in the overall population of patients suspected for this condition, it might influence it according to the presenting complaint that leads to a suspicion of PE."
Gex and colleagues therefore conclude that the presence of AF does not increase the probability of PE, but that "when PE suspicion emerges from a chest pain alone, presence of AF tends to increase PE probability."
"Because this subgroup of patients is free of any bias linked to dyspnea, this strong trend may suggest a true association between these two conditions," they write.
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By Stephanie Leveene