Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism
Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021467 |
| _version_ | 1818589170756485120 |
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| author | Behnood Bikdeli David Jiménez Jorge del Toro Gregory Piazza Agustina Rivas José Luis Fernández‐Reyes Ángel Sampériz Remedios Otero José María Suriñach Carmine Siniscalchi Javier Miguel Martín‐Guerra Joaquín Castro Alfonso Muriel Gregory Y. H. Lip Samuel Z. Goldhaber Manuel Monreal |
| author_facet | Behnood Bikdeli David Jiménez Jorge del Toro Gregory Piazza Agustina Rivas José Luis Fernández‐Reyes Ángel Sampériz Remedios Otero José María Suriñach Carmine Siniscalchi Javier Miguel Martín‐Guerra Joaquín Castro Alfonso Muriel Gregory Y. H. Lip Samuel Z. Goldhaber Manuel Monreal |
| author_sort | Behnood Bikdeli |
| collection | DOAJ |
| description | Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90‐day and 1‐year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90‐day all‐cause (odds ratio [OR], 2.81; 95% CI, 2.33–3.38) and PE‐related mortality (OR, 2.38; 95% CI, 1.37–4.14) and increased 1‐year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10–9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all‐cause mortality (OR, 1.91; 95% CI, 1.57–2.32) but not PE‐related mortality (OR, 1.50; 95% CI, 0.85–2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90‐day all‐cause (OR, 2.28; 95% CI, 1.75–2.97) and PE‐related (OR, 3.64; 95% CI, 2.01–6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset. |
| first_indexed | 2024-12-16T09:36:24Z |
| format | Article |
| id | doaj.art-fc0d5928c02646a4be8225e623b3889e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-16T09:36:24Z |
| publishDate | 2021-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-fc0d5928c02646a4be8225e623b3889e2022-12-21T22:36:24ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-09-01101710.1161/JAHA.121.021467Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary EmbolismBehnood Bikdeli0David Jiménez1Jorge del Toro2Gregory Piazza3Agustina Rivas4José Luis Fernández‐Reyes5Ángel Sampériz6Remedios Otero7José María Suriñach8Carmine Siniscalchi9Javier Miguel Martín‐Guerra10Joaquín Castro11Alfonso Muriel12Gregory Y. H. Lip13Samuel Z. Goldhaber14Manuel Monreal15Cardiovascular Medicine Division Brigham and Women's HospitalHarvard Medical School Boston MARespiratory Department Hospital Ramón y Cajal (IRYCIS) Madrid SpainDepartment of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid SpainCardiovascular Medicine Division Brigham and Women's HospitalHarvard Medical School Boston MADepartment of Pneumonology Hospital Universitario Araba Álava SpainDepartment of Internal Medicine Complejo Hospitalario de Jaén Jaén SpainDepartment of Internal Medicine Hospital Reina Sofía Tudela, Navarra SpainDepartment of Pneumonology Hospital Universitario Virgen del Rocío Seville SpainDepartment of Internal Medicine Hospital Universitario Vall d'Hebron Barcelona SpainDepartment of Angiology Azienda Ospedaliera Universitaria Parma ItalyDepartment of Internal Medicine Hospital Clínico Universitario de Valladolid Valladolid SpainDepartment of Internal Medicine Hospital Santa Bárbara Puertollano, Ciudad Real SpainClinical Biostatistics Unit Hospital Universitario Ramón y CajalIRYCISCIBERESP: Universidad de Alcalá Madrid SpainLiverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United KingdomCardiovascular Medicine Division Brigham and Women's HospitalHarvard Medical School Boston MAHospital Universitari Germans Trias i Pujol Badalona, Barcelona SpainBackground Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90‐day and 1‐year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90‐day all‐cause (odds ratio [OR], 2.81; 95% CI, 2.33–3.38) and PE‐related mortality (OR, 2.38; 95% CI, 1.37–4.14) and increased 1‐year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10–9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all‐cause mortality (OR, 1.91; 95% CI, 1.57–2.32) but not PE‐related mortality (OR, 1.50; 95% CI, 0.85–2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90‐day all‐cause (OR, 2.28; 95% CI, 1.75–2.97) and PE‐related (OR, 3.64; 95% CI, 2.01–6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.https://www.ahajournals.org/doi/10.1161/JAHA.121.021467atrial fibrillationmortalityoutcomepulmonary embolism |
| spellingShingle | Behnood Bikdeli David Jiménez Jorge del Toro Gregory Piazza Agustina Rivas José Luis Fernández‐Reyes Ángel Sampériz Remedios Otero José María Suriñach Carmine Siniscalchi Javier Miguel Martín‐Guerra Joaquín Castro Alfonso Muriel Gregory Y. H. Lip Samuel Z. Goldhaber Manuel Monreal Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation mortality outcome pulmonary embolism |
| title | Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism |
| title_full | Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism |
| title_fullStr | Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism |
| title_full_unstemmed | Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism |
| title_short | Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism |
| title_sort | association between preexisting versus newly identified atrial fibrillation and outcomes of patients with acute pulmonary embolism |
| topic | atrial fibrillation mortality outcome pulmonary embolism |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021467 |
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