Asymptomatic atrial fibrillation had similar risks of all-cause death (OR 1.03; 95% CI 0.81-1.32) and stroke/thromboembolism (OR 1.06; 95% CI 0.86-1.31) compared to symptomatic presentation.
Meta-Analysis (n=81,462)
Does asymptomatic clinical presentation compared to symptomatic presentation affect mortality and thromboembolic events in patients with atrial fibrillation?
Asymptomatic and symptomatic atrial fibrillation carry similar risks for mortality and thromboembolic events, indicating that management strategies should not be based solely on symptomatic status.
Effect estimate: OR 1.03 (95% CI 0.81-1.32)
BACKGROUND: In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation. METHODS: We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months. RESULTS: From the initial 5476 results retrieved after duplicates' removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81-1.32), and cardiovascular death (OR 0.87, 95% CI 0.54-1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77-1.93) and stroke/TE (OR 1.06, 95% CI 0.86-1.31) risks. CONCLUSIONS: Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.
Sgreccia et al. (Thu,) conducted a meta-analysis in Atrial Fibrillation (n=81,462). Asymptomatic atrial fibrillation vs. Symptomatic atrial fibrillation was evaluated on All-cause death (OR 1.03, 95% CI 0.81-1.32). Asymptomatic atrial fibrillation had similar risks of all-cause death (OR 1.03; 95% CI 0.81-1.32) and stroke/thromboembolism (OR 1.06; 95% CI 0.86-1.31) compared to symptomatic presentation.