What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Pulmonary Embolism (n=1142). Intervention: Baseline Atrial Fibrillation vs. No Atrial Fibrillation. Primary outcome: All-cause mortality (HR 1.90, 95% CI 1.54-2.36, p=<0.001).

March 1, 2016Open Access

The Prevalence and Incidence of Atrial Fibrillation in Patients with Acute Pulmonary Embolism

Q: What are the key findings of this study?

Baseline atrial fibrillation in patients presenting with acute pulmonary embolism was associated with significantly higher all-cause mortality compared to patients without atrial fibrillation (HR 1.90).

Q: What does this research mean for the field?

Baseline atrial fibrillation in patients presenting with acute pulmonary embolism is associated with significantly higher all-cause mortality compared to patients without atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Baseline atrial fibrillation in patients presenting with acute pulmonary embolism was associated with significantly higher all-cause mortality compared to patients without atrial fibrillation (HR 1.90).

Study Design

Type

Cohort (n=1,142)

Multicenter

Structured PICO

Population

1,142 patients admitted with a primary diagnosis of acute pulmonary embolism (PE), mean age 67.2, 55% female, from a single tertiary institution in Sydney, Australia.

Outcome

Prevalence of baseline atrial fibrillation and incidence of subsequent atrial fibrillation post-PE

Patients presenting with acute pulmonary embolism have a markedly increased prevalence and subsequent incidence of atrial fibrillation, suggesting a need for post-PE AF screening.

Main Result

Effect estimate: HR 1.90 (95% CI 1.54-2.36)

Absolute Event Rate: 57.5% vs 35%

p-value: p=<0.001

Limitations

Retrospective and single-center design
Did not include patients that died of PE before hospital presentation or had small PEs not requiring hospital admission
Reliance on ICD-10 coding to identify AF patients is subject to potential coding errors
Could not adjust for the impact of anticoagulation use during follow-up on mortality outcomes
Causes of death based on death certificates could be misclassified in the absence of formal autopsy studies

Abstract

BACKGROUND: Symptomatic pulmonary embolism (PE) is a major cause of cardiovascular death and morbidity. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388-661 per 100,000, and 90-123 per 100,000 person-years respectively. However, the prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear. METHODS: Individual patient clinical details were retrieved from a database containing all confirmed acute PE presentations to a tertiary institution from 2001-2012. Prevalence and incidence of AF was tracked from a population registry by systematically searching for AF during any hospital admission (2000-2013) based on International Classification of Disease (ICD-10) code. RESULTS: Of the 1,142 patients included in this study, 935 (81.9%) had no AF during index PE admission whilst 207 patients had documented baseline AF (prevalence rate 18,126 per 100,000; age-adjusted 4,672 per 100,000). Of the 935 patients without AF, 126 developed AF post-PE (incidence rate 2,778 per 100,000 person-years; age-adjusted 984 per 100,000 person-years). Mean time from PE to subsequent AF was 3.4 ± 2.9 years. Total mortality (mean follow-up 5.0 ± 3.7 years) was 42% (n = 478): 35% (n = 283), 59% (n = 119) and 60% (n = 76) in the no AF, baseline AF and subsequent AF cohorts respectively. Independent predictors for subsequent AF after acute PE include age (hazard ratio HR 1.06, 95% confidence interval CI 1.04-1.08, p<0.001), history of congestive cardiac failure (HR 1.88, 95% CI 1.12-3.16, p = 0.02), diabetes (HR 1.72, 95% CI 1.07-2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48-15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90-0.98, p = 0.002). CONCLUSIONS: Patients presenting with acute PE have a markedly increased age-adjusted prevalence and subsequent incidence of AF. Screening for AF may be of importance post-PE.

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