Atrial fibrillation and the risks of cardiovascular disease, renal disease and death: a meta-analysis

Objectives: The relationship between atrial fibrillation (AF) and the development of cardiovascular and renal disease is unclear. We aimed to quantify the associations between AF and cardiovascular disease, renal disease and death. Design: Systematic Review and Meta-analysis. Data Sources: We conducted a systematic search of MEDLINE and EMBASE. Eligibility Criteria: We included cohort studies examining the association of AF with cardiovascular disease, renal disease and death. Two reviewers independently extracted study characteristics and the relative risk of outcomes associated with AF: specifically, all-cause mortality, cardiovascular mortality, major cardiovascular events, any stroke, ischemic stroke, hemorrhagic stroke, ischemic heart disease, sudden cardiac death, congestive heart failure, chronic kidney disease and peripheral arterial disease. Estimates were pooled using inverse-variance weighted random effects meta-analysis. Results: One hundred and four eligible cohort studies involving 9,686,513 participants (587,867 with AF) were identified. AF 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), ischemic stroke (2.33; 1.84 to 2.94), ischemic 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 hemorrhagic stroke (2.00; 0.67 to 5.96). Among the outcomes examined, the absolute risk increase for heart failure was the greatest. Associations of AF with included outcomes were broadly consistent across subgroups and in sensitivity analyses. Conclusions: AF 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 AF