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Epidemiology of atrial fibrillation in patients with cirrhosis and clinical significance

a meta-analysis

Chokesuwattanaskul, Ronpichaia; Thongprayoon, Charatc; Bathini, Tarund; O’Corragain, Oisin Ae; Sharma, Konikaf; Preechawat, Somchaia; Wijarnpreecha, Karng; Kröner, Paul T.g; Ungprasert, Patompongb; Cheungpasitporn, Wisith

European Journal of Gastroenterology & Hepatology: April 2019 - Volume 31 - Issue 4 - p 514–519
doi: 10.1097/MEG.0000000000001315
Original Articles: Hepatology
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Objective The epidemiology of atrial fibrillation (AF) in patients with cirrhosis and its clinical significance remain unclear. This study aimed (i) to investigate the pooled prevalence and/or incidence of AF in patients with cirrhosis and (ii) to assess the mortality risk of AF in patients with cirrhosis.

Patients and methods A literature search for studies that reported incidence of AF in patients with cirrhosis was carried out using Medline, Embase, and Cochrane Database from inception through July 2018. Pooled incidence with 95% confidence interval (CI) was calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018102664).

Results Seven cohort studies including 385 866 patients with cirrhosis were identified. The pooled estimated prevalence of AF in patients with cirrhosis was 5.0% (95% CI: 2.8–8.6%). When studies that solely assessed patients undergoing transplant evaluation or on transplant waiting list were excluded, the pooled estimated prevalence of AF in patients with cirrhosis was 7.4% (95% CI: 3.5–15.2%). There was a significant association between AF and increased mortality risk in cirrhotic patients with a pooled odds ratio of 1.44 (95% CI: 1.36–1.53).

Conclusion The overall estimated prevalence of AF among patients with cirrhosis is 5.0%. Our study demonstrates a statistically significant increased mortality risk in cirrhotic patients with AF.

aDepartment of Medicine, Division of Cardiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society

bDepartment of Research and Development, Clinical Epidemiology Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

cDepartment of Internal Medicine, Mayo Clinic, Rochester, Minnesota

dDepartment of Internal Medicine, University of Arizona, Tucson, Arizona

eDepartment of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania

fDepartment of Internal Medicine, Bassett Medical Center, Cooperstown, New York

gDivision of Gastroenterology, Mayo Clinic, Jacksonville, Florida

hDepartment of Medicine, University of Mississippi Medical Center, Mississippi, USA

Correspondence to Ronpichai Chokesuwattanaskul, MD, King Chulalongkorn Memorial Hospital, Bangkok, Thailand Tel: +66 225 64 265; fax: +66 225 64 356; e-mail: drronpichaic@gmail.com

Received September 13, 2018

Accepted October 25, 2018

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