title: Prognostic Importance of Atrial Fibrillation Timing and Pattern in Adults With Congestive Heart Failure: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Atrial fibrillation (AF) is common among adults with congestive heart failure (CHF). We conducted a meta-analysis to summarize the risk of mortality and cardiovascular disease associated with AF in CHF and stratified our analyses by AF timing and pattern.
  
  
  METHODS
  We searched MEDLINE and EMBASE for observational studies examining the association of AF with cardiovascular disease and death. Eligible studies had a minimum of 50 participants with AF and 50 participants without AF, and a median follow-up of 6 months.
  
  
  RESULTS
  Thirty-three studies involving 114,204 adults (43,549 with AF) were included in this meta-analysis. AF was associated with an increased risk of mortality and this risk varied between incident and prevalent AF (relative risk 2.21, 95% confidence interval 1.96-2.49 vs relative risk 1.19, 95% confidence interval 1.03-1.38, respectively; P < .001 for interaction). The risk of mortality associated with incident AF was consistent in adults with CHF with reduced and preserved ejection fraction. The relative risk of mortality did not vary between paroxysmal and chronic AF. Finally, AF was associated with an increased risk of cardiovascular mortality and stroke.
  
  
  CONCLUSIONS
  Use of anticoagulation was infrequently reported in included studies.
  
  
  CONCLUSIONS
  AF was associated with an increased risk of cardiovascular disease and death and, notably, the risk of mortality varied by AF timing.
authors: University of Oxford, Oxford, United Kingdom. Electronic address: ayodele.odutayo@bnc.ox.ac.uk.
authors: Ayodele
authors: A
authors: Odutayo
authors: University of Oxford, Oxford, United Kingdom.
authors: Christopher X
authors: CX
authors: Wong
authors: Faculty of Medicine, George Washington University, Washington DC.
authors: Rashida
authors: R
authors: Williams
authors: University of Oxford, Oxford, United Kingdom.
authors: Benjamin
authors: B
authors: Hunn
authors: University of Oxford, Oxford, United Kingdom.
authors: Connor A
authors: CA
authors: Emdin
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D014943:Global Health; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Atrial fibrillation; Cardiovascular disease; Congestive heart failure; Mortality