New-Onset Atrial Fibrillation and Adverse In-Hospital Outcome in Patients with Acute Pulmonary Embolism

Jing, Yanyan; Tang, Ri‐Bo; Xu, Zhiyuan; Dong, Jianzeng; Du, Xin; Wu, Jiahui; Yu, Rong‐Hui; Ning, Man; Sang, Caihua; Jiang, Chen‐Xi; Bai, Rong; Liu, Nian; Wen, Shaojun; Li, Songnan; Chen, Xuan; Huang, Shu-Tao; Cui, Yi‐Kai; Ma, Changsheng

doi:10.1055/s-0040-1718397

Cited by 7 publications

(2 citation statements)

References 27 publications

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“…The causes and consequences of AF in PE are still a matter of debate. Our results show that adding the AF variable to ESC mortality risk stratification did not lead to the reclassification of patients to higher-risk groups, which is consistent with the findings in other studies [28]. Interestingly, in women, adding a new-onset paroxysmal AF variable to the ESC mortality risk model did significantly improve its prognostic power for both all-cause and PE-related hospital mortality.…”

Section: Discussionsupporting

confidence: 90%

New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men

et al. 2023

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Background: Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. Methods: In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. Results: There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274–3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004–0.063); p = 0.013). Conclusion: The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.

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Section: Discussionsupporting

confidence: 90%

New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men

et al. 2023

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“…A recent study showed that the inclusion of AF in sPESI could improve the prediction of in-hospital adverse events. 23 In another PE cohort, they found AF group had a high proportion of massive PE and in-hospital mortality. 24 Indeed, the in-hospital mortality of PE combined with AF is 20%-32%, and nearly half of the patients suffer from rightsided intracardiac thrombus.…”

Section: Discussionmentioning

confidence: 96%

Retrospective cohort study of new-onset atrial fibrillation in acute pulmonary embolism on prognosis

et al. 2021

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ObjectivesTo investigate the characteristics of new-onset atrial fibrillation (AF) and its impact on prognosis in acute pulmonary embolism (aPE).DesignA retrospective cohort studySettingThe study cohort included patients diagnosed with aPE who were admitted to the Renmin Hospital of Wuhan University from January 2017 to January 2019.ParticipantsPatients were ≥18 years of age and hospitalised for aPE.Outcome measuresAF was diagnosed based on an ECG recording or a Holter monitor during hospitalisation. aPE was diagnosed by CT pulmonary angiography. The prescription was determined from the discharge medication list. All-cause mortality was observed after 6-month follow-up. The logistic regression model and Cox proportional hazards model were used to study the risk factor of the new-onset AF and the predictor of all-cause mortality, respectively.ResultsA total of 590 patients with aPE were enrolled, 23 (3.9%) in the new-onset paroxysmal AF group, 31 (5.3%) in the new-onset persistent AF group and 536 (90.8%) in the sinus rhythm (SR) group. The incidence of the new-onset AF was 9.2% (54/590). A significant difference in age, heart rate, cardiac troponin I ultra, amino-terminal pro-brain natriuretic peptide, D-dimer, left atrial diameter, left ventricular ejection fraction, pulmonary infection, venous thromboembolism, congestive heart failure, chronic cor pulmonale and ischaemic heart disease was found among the three groups (p<0.05). Risk factors for the new-onset AF were massive PE, ischaemic heart disease and congestive heart failure. The survival rate of the paroxysmal and persistent AF group was significantly lower than that of the SR group within 6 months (60.9% and 51.6% vs 88.8%, p<0.001). New-onset persistent AF (OR 2.73; 95% CI 1.28 to 5.81; p=0.009) was an independent predictor affecting the 6-month survival in aPE patients.ConclusionsMassive PE, ischaemic heart disease and congestive heart failure are high-risk factors which were related to new-onset AF in aPE. New-onset persistent AF was an independent predictor for 6-month all-cause mortality in PE patients.

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Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis

Noubiap¹,

Nyaga²,

Middeldorp³

et al. 2022

Respiratory Medicine

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New-Onset Atrial Fibrillation and Adverse In-Hospital Outcome in Patients with Acute Pulmonary Embolism

Cited by 7 publications

References 27 publications

New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men

New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men

Retrospective cohort study of new-onset atrial fibrillation in acute pulmonary embolism on prognosis

Frequency and prognostic significance of atrial fibrillation in acute pulmonary embolism: A pooled analysis

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