Lan Mu, Harriet Larvin, Ramesh Nadarajah, Chris P Gale, Jianhua Wu
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Meta-regressions explored the influence of age, CHA<sub>₂</sub>DS<sub>₂</sub>-VASc Score (a clinical stroke risk assessment tool for patients with AF), geographic region, study period (pre/post-2011) and sex on IRs.</p><p><strong>Results: </strong>80 studies (5 498 857 patients) were identified, of which 73 studies, representing 24 817 465 person-years of follow-up, were included in the primary meta-analyses of IRs. Cardiovascular events in descending frequency were heart failure (IR 2.98 cases per 100 person-years, 95% CI 2.10 to 4.24), ischaemic stroke (IR 1.76 cases per 100 person-years, 95% CI 1.44 to 2.15), cardiovascular death (IR 1.66 cases per 100 person-years, 95% CI 1.24 to 2.23) and myocardial infarction (0.64 cases per 100 person-year, 95% CI 0.41 to 0.98). Except for heart failure (incidence rate ratio (IRR) 0.66, 95% CI 0.33 to 1.34), study outcomes declined over time (ischaemic stroke IRR 0.56, 95% CI 0.40 to 0.80; cardiovascular death IRR 0.52, 95% CI 0.29 to 0.93; myocardial infarction IRR 0.27, 95% CI 0.14 to 0.49). Sex differences appear to have diminished over time and were not found to be statistically significant in more recent studies.</p><p><strong>Conclusions: </strong>In patients with AF, heart failure was the most common and persistent adverse outcome. Despite improvement in stroke prevention, heart failure incidence has not declined, highlighting the need for targeted strategies and guideline focus. Further research is needed to address heart failure prevention and refine the understanding of sex-specific cardiovascular risks.</p><p><strong>Prospero registration number: </strong>CRD42023474268.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-term cardiovascular risks after atrial fibrillation diagnosis: a systematic review and meta-analysis.\",\"authors\":\"Lan Mu, Harriet Larvin, Ramesh Nadarajah, Chris P Gale, Jianhua Wu\",\"doi\":\"10.1136/heartjnl-2025-326376\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Absolute risk estimates of long-term cardiovascular complications after atrial fibrillation (AF) diagnosis from contemporary cohorts are needed to guide clinical care. Quantifying these risks can inform outcome selection in future randomised clinical trials and improve health service delivery. We systematically reviewed and synthesised incidence rates (IRs), risks and temporal trends of adverse cardiovascular events in patients with AF.</p><p><strong>Methods: </strong>Longitudinal cohort studies published from 2015 onwards, reporting cardiovascular events in AF, were included. IRs were pooled using random-effects meta-analyses. Meta-regressions explored the influence of age, CHA<sub>₂</sub>DS<sub>₂</sub>-VASc Score (a clinical stroke risk assessment tool for patients with AF), geographic region, study period (pre/post-2011) and sex on IRs.</p><p><strong>Results: </strong>80 studies (5 498 857 patients) were identified, of which 73 studies, representing 24 817 465 person-years of follow-up, were included in the primary meta-analyses of IRs. Cardiovascular events in descending frequency were heart failure (IR 2.98 cases per 100 person-years, 95% CI 2.10 to 4.24), ischaemic stroke (IR 1.76 cases per 100 person-years, 95% CI 1.44 to 2.15), cardiovascular death (IR 1.66 cases per 100 person-years, 95% CI 1.24 to 2.23) and myocardial infarction (0.64 cases per 100 person-year, 95% CI 0.41 to 0.98). Except for heart failure (incidence rate ratio (IRR) 0.66, 95% CI 0.33 to 1.34), study outcomes declined over time (ischaemic stroke IRR 0.56, 95% CI 0.40 to 0.80; cardiovascular death IRR 0.52, 95% CI 0.29 to 0.93; myocardial infarction IRR 0.27, 95% CI 0.14 to 0.49). Sex differences appear to have diminished over time and were not found to be statistically significant in more recent studies.</p><p><strong>Conclusions: </strong>In patients with AF, heart failure was the most common and persistent adverse outcome. 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引用次数: 0
摘要
背景和目的：需要对当代队列房颤（AF）诊断后长期心血管并发症的绝对风险估计来指导临床护理。量化这些风险可以为未来随机临床试验的结果选择提供信息，并改善卫生服务的提供。我们系统地回顾和综合了房颤患者不良心血管事件的发生率（IRs）、风险和时间趋势。方法：纳入了2015年以来发表的关于房颤心血管事件的纵向队列研究。使用随机效应荟萃分析汇总ir。meta回归探讨了年龄、CHA₂DS₂-VASc评分（房颤患者卒中风险评估工具）、地理区域、研究期间（2011年前后）和性别对IRs的影响。结果：共纳入80项研究（5 498 857例患者），其中73项研究（24 817 465人-年随访）纳入了ir的主要荟萃分析。频率下降的心血管事件包括心力衰竭（IR 2.98例/ 100人年，95% CI 2.10 - 4.24）、缺血性卒中（IR 1.76例/ 100人年，95% CI 1.44 - 2.15）、心血管死亡（IR 1.66例/ 100人年，95% CI 1.24 - 2.23）和心肌梗死（IR 0.64例/ 100人年，95% CI 0.41 - 0.98）。除心力衰竭外（发病率比（IRR） 0.66, 95% CI 0.33 ~ 1.34），研究结果随时间下降（缺血性卒中IRR 0.56, 95% CI 0.40 ~ 0.80；心血管死亡IRR 0.52, 95% CI 0.29 ~ 0.93；心肌梗死IRR 0.27, 95% CI 0.14 ~ 0.49）。随着时间的推移，性别差异似乎已经减少，在最近的研究中没有发现统计学上的显著差异。结论：在房颤患者中，心力衰竭是最常见和持续的不良后果。尽管中风预防有所改善，但心力衰竭的发病率并未下降，这突出了有针对性的策略和指南重点的必要性。需要进一步的研究来解决心力衰竭的预防问题，并完善对性别特异性心血管风险的理解。普洛斯彼罗注册号：CRD42023474268。
Long-term cardiovascular risks after atrial fibrillation diagnosis: a systematic review and meta-analysis.
Background and aims: Absolute risk estimates of long-term cardiovascular complications after atrial fibrillation (AF) diagnosis from contemporary cohorts are needed to guide clinical care. Quantifying these risks can inform outcome selection in future randomised clinical trials and improve health service delivery. We systematically reviewed and synthesised incidence rates (IRs), risks and temporal trends of adverse cardiovascular events in patients with AF.
Methods: Longitudinal cohort studies published from 2015 onwards, reporting cardiovascular events in AF, were included. IRs were pooled using random-effects meta-analyses. Meta-regressions explored the influence of age, CHA₂DS₂-VASc Score (a clinical stroke risk assessment tool for patients with AF), geographic region, study period (pre/post-2011) and sex on IRs.
Results: 80 studies (5 498 857 patients) were identified, of which 73 studies, representing 24 817 465 person-years of follow-up, were included in the primary meta-analyses of IRs. Cardiovascular events in descending frequency were heart failure (IR 2.98 cases per 100 person-years, 95% CI 2.10 to 4.24), ischaemic stroke (IR 1.76 cases per 100 person-years, 95% CI 1.44 to 2.15), cardiovascular death (IR 1.66 cases per 100 person-years, 95% CI 1.24 to 2.23) and myocardial infarction (0.64 cases per 100 person-year, 95% CI 0.41 to 0.98). Except for heart failure (incidence rate ratio (IRR) 0.66, 95% CI 0.33 to 1.34), study outcomes declined over time (ischaemic stroke IRR 0.56, 95% CI 0.40 to 0.80; cardiovascular death IRR 0.52, 95% CI 0.29 to 0.93; myocardial infarction IRR 0.27, 95% CI 0.14 to 0.49). Sex differences appear to have diminished over time and were not found to be statistically significant in more recent studies.
Conclusions: In patients with AF, heart failure was the most common and persistent adverse outcome. Despite improvement in stroke prevention, heart failure incidence has not declined, highlighting the need for targeted strategies and guideline focus. Further research is needed to address heart failure prevention and refine the understanding of sex-specific cardiovascular risks.
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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