Risk of Hospital Admissions in Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis

Abstract Background Atrial 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. Methods We 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 AF patients, 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. Results Thirty-five studies (n=311,314 patients) were included. The pooled incidence of all-cause hospital admissions was 43.7 (95% CI, 38.5-48.9; I 2 =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 non-cardiovascular hospitalizations (pooled incidence 26.3 [95% CI, 22.7-29.9; I 2 =99.9%] vs 15.7 [95% CI, 12.5-18.9; I 2 =99.8%] per 100 person-years). In meta-regression analyses, older age (β=1.4 [95% CI, 0.33-2.53], P=0.01, R 2 =15.7%) and prevalence of chronic pulmonary disease (β=1.5 [95% CI, 0.57-2.45], P=0.005, R 2 =49.8%) were associated with an increased rate of all-cause hospital admissions. Conclusions Patients with AF have a very high risk of being admitted to the hospital, both for cardiovascular and non-cardiovascular causes. The development and implementation of preventive strategies should be a public health priority.