Atrial fibrillation is frequent but does not affect risk stratification in pulmonary embolism

Abstract

BackgroundAlthough prior studies indicate a high prevalence of atrial fibrillation (AF) in patients with pulmonary embolism (PE), the exact prevalence and prognostic impact are unknown.MethodsWe aimed to investigate the prevalence, risk factors and prognostic impact of AF on risk stratification, in‐hospital adverse outcomes and mortality in 528 consecutive PE patients enrolled in a single‐centre registry between 09/2008 and 09/2017.ResultsOverall, 52 patients (9.8%) had known AF and 57 (10.8%) presented with AF on admission; of those, 34 (59.6%) were newly diagnosed with AF. Compared to patients with no AF, overt hyperthyroidism was associated with newly diagnosed AF (OR 7.89 [2.99–20.86]), whilst cardiovascular risk comorbidities were more frequently observed in patients with known AF. Patients with AF on admission had more comorbidities, presented more frequently with tachycardia and elevated cardiac biomarkers and were hence stratified to higher risk classes. However, AF on admission had no impact on in‐hospital adverse outcome (8.3%) and in‐hospital mortality (4.5%). In multivariate logistic regression analyses corrected for AF on admission, NT‐proBNP and troponin elevation as well as higher risk classes in risk assessment models remained independent predictors of an in‐hospital adverse outcome.ConclusionAtrial fibrillation is a frequent finding in PE, affecting more than 10% of patients. However, AF was not associated with a higher risk of in‐hospital adverse outcomes and did not affect the prognostic performance of risk assessment strategies. Thus, our data support the use of risk stratification tools for patients with acute PE irrespective of the heart rhythm on admission.

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

“…Ebner et al reported that AF on admission with PE 1-year mortality was 17.5%, and it do not affect the prognostic performance. 20 However, they neither distinguished whether AF was subsequent or existed before, nor it was persistent or paroxysmal. In addition, Ng et al showed that subsequent AF with PE 6-month mortality was 10%, 19 while they did not investigate the effects of different AF types on the mortality.…”

“…It has been reported age, congestive heart failure as independent predictors for subsequent AF in PE cohort. [19][20][21] Massive PE, which causes a sharp increase in afterload and stretch injuries, could also be associated with AF. Our study confirmed that massive PE was a risk factor for new-onset AF.…”

“…Our cohort demonstrated that in-hospital and 6-month mortality were higher than the previous studies. [19][20][21][22] Ng et al found that PE with baseline AF had higher mortality than subsequent AF in the first year (23.7% vs 9.5%) and the fifth year (45.4% vs 34.9%), but the latter had higher all-cause mortality during long-term follow-up. 19 These results suggested that the subsequent AF may have an adverse effect on the long-term prognosis.…”

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

“…In a recent cohort study, it was found that AF did not affect risk stratification in PE. 28 The patients with AF on admission had adverse in-hospital outcome in 8.8% compared with those in sinus rhythm (8.3%, p ¼ 0.80). The adverse in-hospital outcome in the patients with newly diagnosed AF 3/34 (8.8%) was not significantly different from those without AF 36/442 (8.1%) or those with known AF 5/52 (9.6%).…”

“…As the author discussed, the prognostic value of AF in acute PE was likely to be small rather than absent. 28 A larger sample size study might have yielded statistically significant differences. In a study based on National Inpatients Sample database in the United States, 201,360 patients with PE were analyzed.…”