Background
Despite progresses in the treatment of the thromboembolic risk related to atrial fibrillation (AF), the management of recurrences remains a challenge.
Hypothesis
To assess if congestive heart failure or left ventricular systolic dysfunction (CHA
2
DS
2
‐VASc) score is predictive of early arrhythmia recurrence after AF cardioversion.
Methods
Systematic review and individual patient pooled meta‐analysis following Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Inclusion criteria: observational trials in patients with AF undergoing cardioversion, available data on recurrence of AF and available data on CHA
2
DS
2
‐VASc score. Clinical studies of interest were retrieved by PubMed, Cochrane Library, and Biomed Central. Seven authors were contacted for joining the patient level meta‐analysis, and three shared data regarding anthropometric measurements, risk factors, major comorbidities, and CHA
2
DS
2
‐VASc score. The primary outcome was the recurrence of AF after cardioversion in patients free from antiarrhythmic prophylaxis. Univariate and multivariate logistic regression was performed.
Results
Overall, we collect data of 2889 patients: 61% were male, 50% with hypertension, 12% with diabetes, and 23% with history of ischemic heart disease. The median CHA2DS2‐VASc score was 2.. At the multivariate analysis, chronic kidney disease (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.12‐3.27;
P
= 0.01), peripheral artery disease (OR 1.65; 95% CI 1.23‐2.19;
P
< 0,0001), previous use of beta blockers (OR 1.5; 95% CI 1.19‐1.88;
P
< 0.0001), and CHA2DS2‐VASc score > 2 (OR 1.37; 95% CI 1.1‐1.68;
P
= 0.002) were independent predictors of early recurrence of AF.
Conclusions
CHA2DS2‐VASc score predicts early recurrence of AF in the first 30 days after electrical or pharmacological cardioversion.
Protocol registration
PROSPERO (CRD42017075107).
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Admission anaemia significantly influences all-cause mortality in patients with STEMI treated invasively ina six-year follow-up and may be used for risk stratification in this population.
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