Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis.
OBJECTIVE
To quantify the association between atrial fibrillation and cardiovascular disease, renal disease, and death.


METHODS
Systematic review and meta-analysis.


METHODS
Medline and Embase.


METHODS
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.
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK ayodele.odutayo@bnc.ox.ac.uk.
Ayodele
A
Odutayo
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Christopher X
CX
Wong
Department of Economics, Massachusetts Institute of Technology, Cambridge, MA, USA.
Allan J
AJ
Hsiao
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Sally
S
Hopewell
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Douglas G
DG
Altman
St John's College, University of Oxford, Oxford, UK.
Connor A
CA
Emdin
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000401:mortality; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality