The Prevalence and Incidence of Atrial Fibrillation in Patients with Acute Pulmonary Embolism

BackgroundSymptomatic pulmonary embolism (PE) is a major cause of cardiovascular death and morbidity. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388–661 per 100,000, and 90–123 per 100,000 person-years respectively. However, the prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear.MethodsIndividual patient clinical details were retrieved from a database containing all confirmed acute PE presentations to a tertiary institution from 2001–2012. Prevalence and incidence of AF was tracked from a population registry by systematically searching for AF during any hospital admission (2000–2013) based on International Classification of Disease (ICD-10) code.ResultsOf the 1,142 patients included in this study, 935 (81.9%) had no AF during index PE admission whilst 207 patients had documented baseline AF (prevalence rate 18,126 per 100,000; age-adjusted 4,672 per 100,000). Of the 935 patients without AF, 126 developed AF post-PE (incidence rate 2,778 per 100,000 person-years; age-adjusted 984 per 100,000 person-years). Mean time from PE to subsequent AF was 3.4 ± 2.9 years. Total mortality (mean follow-up 5.0 ± 3.7 years) was 42% (n = 478): 35% (n = 283), 59% (n = 119) and 60% (n = 76) in the no AF, baseline AF and subsequent AF cohorts respectively. Independent predictors for subsequent AF after acute PE include age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04–1.08, pp = 0.02), diabetes (HR 1.72, 95% CI 1.07–2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48–15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90–0.98, p = 0.002).ConclusionsPatients presenting with acute PE have a markedly increased age-adjusted prevalence and subsequent incidence of AF. Screening for AF may be of importance post-PE.**背景** 有症状的肺血栓栓塞症（pulmonary embolism, PE）是引发心血管死亡与致残的主要病因之一。据估算，发达国家心房颤动（atrial fibrillation, AF）的患病率为每10万人388~661例，年发病率为每10万人年90~123例。然而，急性PE患者的AF患病率、发病率及其相关预测因素目前仍不明确。 **方法** 本研究从某三级医疗机构2001-2012年收录的所有确诊急性PE病例数据库中，提取了每名患者的临床详细信息。同时，基于国际疾病分类第十版（International Classification of Disease, ICD-10）编码，通过系统检索2000-2013年期间所有住院患者的病历，从人群登记系统中追踪AF的患病率与发病率。 **结果** 本研究共纳入1142例患者，其中935例（81.9%）在本次PE住院期间未发生AF，另有207例患者存在明确的基线AF（患病率为每10万人18126例，年龄校正后为每10万人4672例）。在935例无基线AF的患者中，有126例在PE发病后新发AF，年发病率为每10万人年2778例，年龄校正后为每10万人年984例。从PE发病至后续新发AF的平均时间为3.4±2.9年。本研究的总死亡率（平均随访时长5.0±3.7年）为42%（n=478）：无AF队列、基线AF队列及后续新发AF队列的死亡率分别为35%（n=283）、59%（n=119）及60%（n=76）。急性PE后新发AF的独立预测因素包括年龄[风险比（hazard ratio, HR）=1.06，95%置信区间（confidence interval, CI）：1.04~1.08，P=0.02]、糖尿病（HR=1.72，95%CI：1.07~2.77，P=0.02）、阻塞性睡眠呼吸暂停（HR=4.83，95%CI：1.48~15.8，P=0.009）以及本次PE住院首日的血清钠水平（HR=0.94，95%CI：0.90~0.98，P=0.002）。 **结论** 急性PE患者的AF年龄校正患病率及后续新发发病率均显著升高，因此PE发病后开展AF筛查或具有重要临床价值。