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Major clinical outcomes in symptomatic vs. asymptomatic atrial fibrillation: a meta-analysis

医学 内科学 危险系数 心房颤动 优势比 无症状的 置信区间 冲程(发动机) 心力衰竭 荟萃分析 心肌梗塞 心脏病学 机械工程 工程类
作者
Paschalis Karakasis,Konstantinos Pamporis,Konstantinos C. Siontis,Panagiotis Theofilis,Athanasios Samaras,Dimitrios Patoulias,Panagiotis Stachteas,Efstratios Karagiannidis,George Stavropoulos,Apostolos Tzikas,George Kassimis,George Giannakoulas,Theodoros D. Karamitsos,Demosthenes G. Katritsis,Nikolaos Fragakis
出处
期刊:European Heart Journal [Oxford University Press]
标识
DOI:10.1093/eurheartj/ehae694
摘要

Abstract Background and Aims Current guidelines suggest that asymptomatic atrial fibrillation (AF) is independently associated with increased risks of stroke and mortality compared with symptomatic AF. Considering that recent investigations have provided conflicting results, the present study aimed to evaluate the association between symptom status and clinical outcomes in patients with AF. Methods Medline, Cochrane Library, and Scopus were searched until 25 March 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using random-effects meta-analyses. Results Thirty-six studies (217 850 participants) were included. Based on the frequentist analysis, symptomatic individuals had no significant difference in the risk of all-cause mortality [hazard ratio (HR) .97, 95% confidence interval (CI) .80–1.17], cardiovascular mortality (HR 1.04, 95% CI .72–1.49), thromboembolism (HR 1.06, 95% CI .87–1.28), stroke (HR 1.06, 95% CI .84–1.34), hospitalization (HR 1.34, 95% CI .89–2.02), and myocardial infarction (HR .98, 95% CI .70–1.36), compared to the asymptomatic group. Symptomatic patients had a 33% increased risk of new-onset heart failure (HR 1.33, 95% CI 1.19–1.49) and a 30% lower risk of progression to permanent AF (HR .70, 95% CI .54–.89). The Bayesian analysis yielded comparable results, yet the association between symptom status and new-onset heart failure was not significant (HR 1.27, 95% credible interval .76–1.93; Bayes factor = 1.2). Symptomatic patients had higher odds of receiving antiarrhythmic drugs (odds ratio [OR] 1.64, 95% CI 1.33–2.03) and ablation therapy (OR 1.47, 95% CI 1.06–2.05) compared to asymptomatic cases. Conclusions The risk of major clinical outcomes did not differ between individuals with and without AF-related symptoms. Asymptomatic patients had a greater hazard of progression to permanent AF.
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