The Prevalence and Incidence of Atrial Fibrillation in Patients with Acute Pulmonary Embolism

Abstract

BackgroundSymptomatic pulmonary embolism (PE) is a major cause of cardiovascular death and morbidity. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388–661 per 100,000, and 90–123 per 100,000 person-years respectively. However, the prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear.MethodsIndividual patient clinical details were retrieved from a database containing all confirmed acute PE presentations to a tertiary institution from 2001–2012. Prevalence and incidence of AF was tracked from a population registry by systematically searching for AF during any hospital admission (2000–2013) based on International Classification of Disease (ICD-10) code.ResultsOf the 1,142 patients included in this study, 935 (81.9%) had no AF during index PE admission whilst 207 patients had documented baseline AF (prevalence rate 18,126 per 100,000; age-adjusted 4,672 per 100,000). Of the 935 patients without AF, 126 developed AF post-PE (incidence rate 2,778 per 100,000 person-years; age-adjusted 984 per 100,000 person-years). Mean time from PE to subsequent AF was 3.4 ± 2.9 years. Total mortality (mean follow-up 5.0 ± 3.7 years) was 42% (n = 478): 35% (n = 283), 59% (n = 119) and 60% (n = 76) in the no AF, baseline AF and subsequent AF cohorts respectively. Independent predictors for subsequent AF after acute PE include age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04–1.08, p<0.001), history of congestive cardiac failure (HR 1.88, 95% CI 1.12–3.16, p = 0.02), diabetes (HR 1.72, 95% CI 1.07–2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48–15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90–0.98, p = 0.002).ConclusionsPatients presenting with acute PE have a markedly increased age-adjusted prevalence and subsequent incidence of AF. Screening for AF may be of importance post-PE.

Pulmonary Embolism and Atrial Fibrillation: Two Sides of the Same Coin? A Systematic Review

“…Specifically, we identified nine studies that reported the prognostic significance of coexisting AF in patients with PE, the majority of which (all but one) hinted at the prognostic significance of coexisting AF on clinical outcomes (►Table 3). 37,53,54,56,58,59,[93][94][95] Finally, a recent systematic review of the literature on the significance of electrocardiographic findings in patients with PE, which was only partially inclusive of the studies discussed here, indicated that the presence of AF is associated with increased risk of circulatory shock and death. 96 Abbreviations: AF, atrial fibrillation; CI, confidence interval; CT, computed tomography; DVT, deep vein thrombosis; PE, pulmonary embolism; VTE, venous thromboembolism.…”

“…While a few studies have specifically discussed this association, the data about coexisting AF in patients with PE are available from several other studies. AF has been described at the time of PE presentation, 8,37, during the course of hospital stay or within the first few weeks, [40][41][42][43]46,50,51,[57][58][59][60][61][62][63][64][65][66][67] and during extended follow-up 56,66 (total of 31 studies, ►Table 1). Of note, one study suggested that prevalence of coexisting AF and incidence of subsequent AF are significantly higher in patients with PE, compared with the age-adjusted rates in the population.…”

“…Of note, one study suggested that prevalence of coexisting AF and incidence of subsequent AF are significantly higher in patients with PE, compared with the age-adjusted rates in the population. 56 We identified only one study of patients with background PE versus controls that reported subsequent rates of AF as an outcome. That study reported higher rates of AF among patients with PE compared with controls (hazard ratio: 1.78, 95% confidence interval [CI]: 1.13-2.80).…”

Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

“…On admission, demographic and clinical characteristics, including symptoms, hemodynamic profile, oxygen saturation, length of hospital stay, risk factors for PE, and comorbidities, were evaluated and compared between the groups. In addition, the probability of PE was evaluated retrospectively using the revised version of the Geneva score rule [ 4 , 5 ], and the Simplified Pulmonary Embolism Severity Index (sPESI) was calculated retrospectively. The following laboratory parameters were also measured on admission: complete blood count, levels of troponin I, D-dimer, and estimated glomerular filtration rate (eGFR, using the Modification of Diet in Renal Disease formula).…”

Comorbid Pathology in Patients With Atrial Fibrillation and Pulmonary Embolism

“…В дальнейшем, после развития ТЭЛА, ФП выявлялась у 14% лиц, составив, таким образом, за время исследования в целом 32,1% случаев при средней продолжительности наблюдения 5,0±3,7 года. На основании исследования в качестве наиболее значимых независимых предикторов развития ФП после острой ТЭЛА были выделены зафиксированная в анамнезе застойная сердечная недостаточность -отношение шансов (ОШ) 1,88; 95% ДИ [1,16] [7].…”