Abstract
Background
Atrial fibrillation (AF) is associated with multiple comorbidities and various adverse
outcome events, suggesting a high risk of hospital admissions in this patient population.
However, its exact incidence and potential underlying causes are not well defined.
The objective of this systematic review was to investigate the incidence and risk
factors for hospital admissions in patients with AF.
Methods
We systematically searched MEDLINE, EMBASE, and CENTRAL for studies providing information
on all-cause hospital admissions. Studies were included if they provided information
on the incidence of all-cause hospital admissions in ≥ 100 patients with AF, and had
≥ 1 year of follow-up. Incidence estimates were pooled using random-effects models.
Meta-regression analysis was performed to identify characteristics associated with
between-study heterogeneity.
Results
Thirty-five studies (n = 311,314 patients) were included. The pooled incidence of
all-cause hospital admissions was 43.7 (95% confidence interval [CI], 38.5-48.9; I2 = 99.9%) per 100 person-years. In 24 studies (n = 234,028 patients) that provided
information on admission causes, cardiovascular hospitalizations were more common
than noncardiovascular hospitalizations (pooled incidence 26.3 [95% CI, 22.7-29.9;
I2 = 99.9%] vs 15.7 [95% CI, 12.5-18.9; I2 = 99.8%] per 100 person-years). In meta-regression analyses, older age (β = 1.4 [95%
CI, 0.33-2.53], P = 0.01, R2 = 15.7%) and prevalence of chronic pulmonary disease (β = 1.5 [95% CI, 0.57-2.45],
P = 0.005, R2 = 49.8%) were associated with an increased rate of all-cause hospital admissions.
Conclusions
Patients with AF have a very high risk of being admitted to the hospital, both for
cardiovascular and noncardiovascular causes. The development and implementation of
preventive strategies should be a public health priority.
Résumé
Contexte
La fibrillation auriculaire (FA) est associée à de multiples maladies concomitantes
et à diverses issues défavorables, ce qui donne à penser qu’un risque élevé d’hospitalisation
existe au sein de la population de patients qu’elle touche. Cependant, son incidence
exacte et ses causes sous-jacentes potentielles ne sont pas bien définies. Le présent
article propose une revue systématique des données sur l’incidence et les facteurs
de risque d’hospitalisation chez les patients atteints de FA.
Méthodologie
Nous avons effectué dans MEDLINE, EMBASE et CENTRAL une recherche systématique d’études
fournissant des renseignements sur les hospitalisations toutes causes confondues.
Les études retenues pour les besoins de notre revue de données devaient fournir des
renseignements sur l’incidence des hospitalisations toutes causes confondues chez
≥ 100 patients atteints de FA et comporter une période de suivi d’au moins un an.
Les estimations de l’incidence ont été regroupées à l’aide de modèles à effets aléatoires.
Une analyse de métarégression a été effectuée afin de cerner les caractéristiques
associées à l’hétérogénéité interétude.
Résultats
Trente-cinq études (n = 311 314 patients) ont été retenues. L’incidence des hospitalisations
toutes causes confondues chez ces patients après regroupement des données s’est établie
à 43,7 (intervalle de confiance [IC] à 95 % de 38,5 à 48,9; I2 = 99,9 %) par 100 années-personnes. Dans 24 études (n = 234 028 patients) qui comportaient
des renseignements sur les causes d’admission, les hospitalisations attribuables à
des causes cardiovasculaires étaient plus fréquentes que les hospitalisations attribuables
à des causes autres que cardiovasculaires (incidence après regroupement des données
de 26,3 [IC à 95 % de 22,7 à 29,9; I2 = 99,9 %] vs 15,7 [IC à 95 % de 12,5 à 18,9; I2 = 99,8 %] par 100 années-personnes). Dans les analyses de métarégression, l’âge avancé
(β = 1,4 [IC à 95 % de 0,33 à 2,53], P = 0,01, R2 = 15,7 %) et la prévalence de maladies pulmonaires chroniques (β = 1,5 [IC à 95 %
de 0,57 à 2,45], P = 0,005, R2 = 49,8 %) étaient associés à une augmentation du taux d’hospitalisation toutes causes
confondues.
Conclusions
Les patients atteints de FA courent un risque très élevé d’hospitalisation tant pour
des causes cardiovasculaires que non cardiovasculaires. L’élaboration et la mise en
œuvre de stratégies de prévention devraient être une priorité de santé publique.
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Article info
Publication history
Published online: May 24, 2019
Accepted:
May 21,
2019
Received:
April 2,
2019
Footnotes
See editorial by Samuel and Brophy, pages 1291–1293 of this issue.
See page 1341 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Challenges in Assessing the Incidence of Atrial Fibrillation HospitalizationsCanadian Journal of CardiologyVol. 35Issue 10
- PreviewAtrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, affecting 1%-4% of the global population.1 The lifetime risk of developing AF is approximately 25%, which increases with age and other risk factors.2 It is currently estimated that 33.5 million people worldwide3 and more than 350,000 Canadians4 have AF and the prevalence is expected to increase threefold over the next 3 decades with experts categorizing the disease as a future epidemic.5 The increasing prevalence has important public health implications because AF is responsible for more disability than any other cardiac arrhythmia.
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