Prevalence of new-onset atrial fibrillation in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis

Abstract

Community-acquired pneumonia (CAP) is a common lower respiratory tract infection, often complicated by cardiovascular events, including cardiac arrhythmias. New-onset atrial fibrillation (newAF) has been associated with increased mortality in CAP patients, especially in those critically ill; however, limited data on the prevalence of newAF in patients with CAP are available. We aim to estimate the pooled prevalence of newAF and its impact on adverse outcomes in patients with CAP, through a systematic review and meta-analysis. MEDLINE and EMBASE were systematically searched from inception to 27 January 2022. All studies reporting the prevalence of newAF in CAP patients were included and all-cause mortality was extracted when available. The pooled prevalence of newAF, 95% Confidence Intervals (CI), and 95% Prediction Intervals (PI) were computed. The inconsistency index (I 2 ) was calculated to measure heterogeneity. Subgroup analyses were also performed. A protocol for this study was registered on PROSPERO (CRD42022307422). Among 7,655 records retrieved, 10 studies were included, with a total of 280,589 CAP patients. Pooled prevalence of newAF in CAP patients was 7.6% (95% CI 6.4–9.0%, 95% PI 4.3–13.1%, I 2 = 95%). Subgroup analyses showed no significant differences according to geographical location or study design. Patients with newAF had a higher risk of mortality among the studies included in the systematic review. NewAF is a common complication, occurring in 7.6% of CAP patients, with prediction intervals suggesting an even higher burden. CAP patients who develop newAF during hospitalization may be at higher risk of mortality in both short- and long-term follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-022-03135-1.

Prediction of new-onset atrial fibrillation with the C2HEST score in patients admitted with community-acquired pneumonia

“…This may be helpful to clinicians to select patients that have benefits from a screening to early detect NOAF so reducing the risk of thromboembolic stroke starting an adequate anticoagulant therapy. It's notable that cardiovascular complications, including NOAF, have been linked to increased short-and long-term mortality risks in this setting [7,35] and a recent evidences suggests that NOAF itself may increase the mortality risk in CAP patients [8,36]. Of note, in our study the hospital stay was longer in patients who experienced NOAF.…”

Prevalence and clinical implications of atrial fibrillation in patients hospitalized due to COVID-19: Data from a registry in Poland

“…The above indicates that a recorded first-time episode of AF triggered by pulmonary infection cannot be viewed as benign, transient, or insignificant. The results of other investigators also indicate that patients with de novo AF discovered during a pulmonary infection, especially in the absence of previously effective anticoagulation, have an increased risk of adverse events and require special attention ( 49 ).…”

“…On the basis of our work, it is also worth considering whether the correlations we have shown regarding the relationship between atrial fibrillation and the clinical course during SARS-CoV2 infection are not also universal for other pathogens (viral or bacterial) leading to pneumonia, sepsis or septic shock. Based on an analysis of the available literature, it should be noted that the relationship between AF and pneumonia had been well described in pre-COVID-19 era ( 49 , 50 ), however there is a lack of extensive comparative analyses of the association between AF and pneumonia depending on the pathogen causing it (SARS-CoV2 vs. other viral or bacterial infections). Comparative data on differences in the incidence of thromboembolic events in patients with SARS-CoV2-induced pneumonia compared to other pathogens responsible for pneumonia are also scarce ( 51 ).…”

Electronic health record-wide association study for atrial fibrillation in a British cohort

“…The association between AF and cancer had previously been reported ( 18 , 19 ). Similarly, sepsis ( 20 ) and other forms of infection ( 21 ) have been reported as important complications associated with new-onset AF.…”