Risk of Hospital Admissions in Patients With Atrial Fibrillation: A Systematic Review and Meta-analysis |
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| Affiliation: | 1. Division of Cardiology, Department of Medicine, University Hospital Basel, Switzerland;2. Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland;3. Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Switzerland;4. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;5. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada;1. Research Institute of the McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada;2. Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Qué́bec City, Quebec, Canada;1. Montreal Heart Institute, Montréal, Québec, Canada;2. Université de Montréal, Montréal, Québec, Canada;3. Duke Clinical Research Institute, Durham, North Carolina, USA;4. Department of Clinical and Experimental Medicine, Policlinic “G. Martino,” University of Messina, Messina, Italy;1. Medical Student, University of Sherbrooke, Sherbrooke, Québec, Canada;2. Radiology Department, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada;3. Medicine Department, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada;4. Surgery Department, Montreal Heart Institute, Université de Montréal, Montréal, Montréal, Québec, Canada;5. Pathology Department, Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec City, Québec, Canada;6. Medicine Department, Sacré-Coeur’s Hospital, Université de Montréal, Montréal, Québec, Canada;1. Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada;2. Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada;3. Population Health Research Institute, Hamilton, Ontario, Canada;4. Department of Surgery, McMaster University, Hamilton, Ontario, Canada;5. Department of Medicine, McMaster University, Hamilton, Ontario, Canada |
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| Abstract: | BackgroundAtrial 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.MethodsWe 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.ResultsThirty-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.ConclusionsPatients 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. |
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