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Review
. 2021 Sep 2;10(17):3979.
doi: 10.3390/jcm10173979.

Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients

Daria Sgreccia  1 , Marcella Manicardi  1 , Vincenzo Livio Malavasi  1 , Marco Vitolo  1   2   3 , Anna Chiara Valenti  1 , Marco Proietti  3   4   5 , Gregory Y H Lip  3   6 , Giuseppe Boriani  1
Affiliations
Review

Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients

Daria Sgreccia et al. J Clin Med. .

Abstract

Background: In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation.

Methods: We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months.

Results: From the initial 5476 results retrieved after duplicates' removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81-1.32), and cardiovascular death (OR 0.87, 95% CI 0.54-1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77-1.93) and stroke/TE (OR 1.06, 95% CI 0.86-1.31) risks.

Conclusions: Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.

Keywords: atrial fibrillation; meta-analysis; mortality; outcomes; stroke; symptoms.

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Conflict of interest statement

G.B.: small speaker fee from Medtronic, Boston, Boehringer Ingelheim and Bayer. G.Y.H.L.: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study selection process (PRISMA Flow Diagram).
Figure 2
Figure 2
All cause and cardiovascular mortality. Panel (A) All-cause death in asymptomatic and symptomatic AF patients. Panel (B) Cardiovascular death in asymptomatic and symptomatic AF patients.
Figure 3
Figure 3
Stroke and thromboembolic events. Panel (A) Thromboembolic events/stroke in asymptomatic and symptomatic AF patients. Panel (B) Stroke in asymptomatic and symptomatic AF patients.
Figure 3
Figure 3
Stroke and thromboembolic events. Panel (A) Thromboembolic events/stroke in asymptomatic and symptomatic AF patients. Panel (B) Stroke in asymptomatic and symptomatic AF patients.
See this image and copyright information in PMC

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