Atrial fibrillation (AF) is associated with an increased risk of death, heart failure, chronic kidney disease and major cardiovascular events as well as stroke, a large meta-analysis has found.

A systematic review and meta-analysis of cohort studies was carried out to examine the association between AF and cardiovascular disease, renal disease, and death.

A search on Embase and Medline identified 104 eligible studies involving 9,686,513 participants, of whom 587,867 had AF.

Two reviewers independently extracted study characteristics and the relative risk of outcomes associated with AF. The outcomes analysed were 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.

AF was associated with an increased relative risk for: all cause mortality, cardiovascular mortality, major cardiovascular events, stroke, ischaemic stroke, ischaemic heart disease, sudden cardiac death, heart failure, chronic kidney disease and peripheral arterial disease but not haemorrhagic stroke, see table 1. Associations between AF and these outcomes were broadly consistent across subgroups.

The highest absolute risk increase associated with AF was for incident congestive heart failure 11.1 events/1,000 participant-years followed by chronic kidney disease 6.6 events/1,000 participant-years. Respective values for ischaemic stroke, cardiovascular mortality and ischaemic heart disease were: 2.9, 2.6 and 1.4 events/1,000 participant-years.

The authors conclude that AF is associated with cardiovascular and renal events as well as stroke and all cause mortality.

‘The relative and absolute risk increase associated with many of these events is greater than that of stroke,’ they point out.

This is an important conclusion for clinical practice as often the focus in AF is on thromboembolic stroke reduction with a low threshold for anticoagulation and symptom control whereas clinicians should also consider interventions aimed at reducing non stroke outcomes.

‘Even though the associations we describe cannot indicate causality for the non stroke outcomes, there is merit in developing clinical risk prediction models for outcomes such as congestive heart failure,’ the authors add.

Dr Peter Savill