Embolic and Other Adverse Outcomes in Symptomatic Versus Asymptomatic Patients With Atrial Fibrillation (from the ORBIT-AF Registry)

Thind, Munveer; Holmes, DaJuanicia N.; Badri, Marwan; Pieper, Karen S.; Singh, Amitoj; Blanco, Rosalia; Steinberg, Benjamin A.; Fonarow, Gregg C.; Gersh, Bernard J.; Mahaffey, Kenneth W.; Peterson, Eric D.; Reiffel, James A.; Piccini, Jonathan P.; Kowey, Peter R.; Investigators, Orbit-Af; Patients,

doi:10.1016/j.amjcard.2018.07.045

Cited by 15 publications

(12 citation statements)

References 30 publications

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“…The remaining 38 were evaluated through full text revision. Finally, 10 articles fulfilled the inclusion criteria and were included in the analysis (Figure 1) [17,[19][20][21][22][23][24][29][30][31].…”

Section: Resultsmentioning

confidence: 99%

“…Study design and baseline characteristics of the included studies are summarized in Table 1. Of the 10 studies included, 2 were retrospective observational studies [23,28], 6 were observational prospective studies [20][21][22]24,30,31], and 2 were derived from clinical randomized trials [17,19]. Studies ranged from 2005 to 2021, while the sample size ranged from 334 to 52,032 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The evaluation of symptoms was different in the studies considered, but comparable, and appeared sufficiently suitable and complete to identify the presence or absence of AF-related symptoms. Some studies [22,24,30] used the EHRA score, two studies used a symptom checklist [17,19], while the remaining studies [20,21,23,29,31] evaluated symptoms according to physician's clinical judgment. An overview of the tools used to identify AF-related symptoms is shown in detail in Table S4.…”

Section: Resultsmentioning

confidence: 99%

“…All-cause mortality was available for six studies [19][20][21][22][23][24]. No significant differences were found between symptomatic and asymptomatic patients (OR 1.03, 95% CI 0.81-1.32); however, there was considerable heterogeneity (I 2 = 86%) (Figure 2 Four studies [17,21,23,29] reported data on cardiovascular death, with no significant differences between symptomatic and asymptomatic AF (OR 0.87, 95% CI 0.54-1.39) (Figure 2B).…”

Section: All-cause and Cardiovascular Mortalitymentioning

confidence: 99%

“…Although the presence of symptoms may guide the decision between rate or rhythm control therapy, it is unclear if asymptomatic or symptomatic clinical presentations are related to outcomes. The evidence is conflicting as several studies have reported that asymptomatic patients show similar risk for TE, in particular ischemic stroke and death, compared with symptomatic patients [20][21][22][23]. On the other hand, other studies have reported an association between mortality, TE, and silent AF [24,25].…”

Section: Introductionmentioning

confidence: 99%

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Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients

Sgreccia

Manicardi

Malavasi

et al. 2021

JCM

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Background: In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation. Methods: We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months. Results: From the initial 5476 results retrieved after duplicates’ removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81–1.32), and cardiovascular death (OR 0.87, 95% CI 0.54–1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77–1.93) and stroke/TE (OR 1.06, 95% CI 0.86–1.31) risks. Conclusions: Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.

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