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Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4482 (Published 06 September 2016) Cite this as: BMJ 2016;354:i4482
  1. Ayodele Odutayo, DPhil student1,
  2. Christopher X Wong, cardiology fellow2,
  3. Allan J Hsiao, PhD student3,
  4. Sally Hopewell, university research lecturer1,
  5. Douglas G Altman, professor1,
  6. Connor A Emdin, DPhil student4
  1. 1Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  2. 2Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, USA
  4. 4St John’s College, University of Oxford, Oxford, UK
  1. Correspondence to: A Odutayo ayodele.odutayo{at}bnc.ox.ac.uk
  • Accepted 10 August 2016

Abstract

Objective To quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death.

Design Systematic review and meta-analysis.

Data sources Medline and Embase.

Eligibility criteria Cohort studies examining the association between atrial fibrillation and cardiovascular disease, renal disease, and death. Two reviewers independently extracted study characteristics and the relative risk of outcomes associated with atrial fibrillation: specifically, all cause mortality, cardiovascular mortality, major cardiovascular events, any stroke, ischaemic stroke, haemorrhagic stroke, ischaemic heart disease, sudden cardiac death, congestive heart failure, chronic kidney disease, and peripheral arterial disease. Estimates were pooled with inverse variance weighted random effects meta-analysis.

Results 104 eligible cohort studies involving 9 686 513 participants (587 867 with atrial fibrillation) were identified. Atrial fibrillation was associated with an increased risk of all cause mortality (relative risk 1.46, 95% confidence interval 1.39 to 1.54), cardiovascular mortality (2.03, 1.79 to 2.30), major cardiovascular events (1.96, 1.53 to 2.51), stroke (2.42, 2.17 to 2.71), ischaemic stroke (2.33, 1.84 to 2.94), ischaemic heart disease (1.61, 1.38 to 1.87), sudden cardiac death (1.88, 1.36 to 2.60), heart failure (4.99, 3.04 to 8.22), chronic kidney disease (1.64, 1.41 to 1.91), and peripheral arterial disease (1.31, 1.19 to 1.45) but not haemorrhagic stroke (2.00, 0.67 to 5.96). Among the outcomes examined, the highest absolute risk increase was for heart failure. Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses.

Conclusions Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease. Interventions aimed at reducing outcomes beyond stroke are warranted in patients with atrial fibrillation.

Footnotes

  • Contributors: AO and CAE conceived and designed the study, carried out the statistical analysis, had full access to all the data in the study, take responsibility for the integrity of the data and the accuracy of the data analysis, and are guarantors. All authors acquired data, analysed and interpreted data, drafted the manuscript, and critically revised the manuscript for important intellectual content.

  • Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. AO, CXW, AJH, and CAE are supported by the Rhodes Trust.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: Data and code are available from the lead author on request.

  • Transparency: The lead authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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