Søgaard, Mette 
ORCID: 0000-0002-2830-4968, Skjøth, Flemming, Nielsen, Peter B ORCID: 0000-0003-2922-6970, Smit, Jesper, Dalager-Pedersen, Michael ORCID: 0000-0002-3220-2526, Larsen, Torben B and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2022)
Thromboembolic Risk in Patients With Pneumonia and New-Onset Atrial Fibrillation Not Receiving Anticoagulation Therapy.
JAMA network open, 5 (5).
e2213945-.
Abstract
<h4>Importance</h4>New-onset atrial fibrillation (AF) is commonly reported in patients with severe infections. However, the absolute risk of thromboembolic events without anticoagulation remains unknown.<h4>Objective</h4>To investigate the thromboembolic risks associated with AF in patients with pneumonia, assess the risk of recurrent AF, and examine the association of initiation of anticoagulation therapy with new-onset AF.<h4>Design, setting, and participants</h4>This population-based cohort study used linked Danish nationwide registries. Participants included patients hospitalized with incident community-acquired pneumonia in Denmark from 1998 to 2018. Statistical analysis was performed from August 15, 2021, to March 12, 2022.<h4>Exposures</h4>New-onset AF.<h4>Main outcomes and measures</h4>Thromboembolic events, recurrent AF, and all-cause death. Estimated risks were calculated for thromboembolism without anticoagulation therapy, new hospital or outpatient clinic contact with AF, initiation of anticoagulation therapy, and all-cause death at 1 and 3 years of follow-up. Death was treated as a competing risk, and inverse probability of censoring weights was used to account for patient censoring if they initiated anticoagulation therapy conditioned on AF.<h4>Results</h4>Among 274 196 patients hospitalized for community-acquired pneumonia, 6553 patients (mean age [SD], 79.1 [11.0] years; 3405 women [52.0%]) developed new-onset AF. The 1-year risk of thromboembolism was 0.8% (95% CI, 0.8%-0.8%) in patients without AF vs 2.1% (95% CI, 1.8%-2.5%) in patients with new-onset AF without anticoagulation; this risk was 1.4% (95% CI, 1.0%-2.0%) among patients with AF with intermediate stroke risk and 2.8% (95% CI, 2.3%-3.4%) in patients with AF with high stroke risk. Three-year risks were 3.5% (95% CI, 2.8%-4.3%) among patients with intermediate stroke risk and 5.3% (95% CI, 4.4%-6.5%) among patients with high stroke risk. Among patients with new-onset AF, 32.9% (95% CI, 31.8%-34.1%) had a new hospital contact with AF, and 14.0% (95% CI, 13.2%-14.9%) initiated anticoagulation therapy during the 3 years after incident AF diagnosis. At 3 years, the all-cause mortality rate was 25.7% (95% CI, 25.6%-25.9%) in patients with pneumonia without AF vs 49.8% (95% CI, 48.6%-51.1%) in patients with new-onset AF.<h4>Conclusions and relevance</h4>This cohort study found that new-onset AF after community-acquired pneumonia was associated with an increased risk of thromboembolism, which may warrant anticoagulation therapy. Approximately one-third of patients had a new hospital or outpatient clinic contact for AF during the 3-year follow-up, suggesting that AF triggered by acute infections is not a transient, self-terminating condition that reverses with resolution of the infection.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Pneumonia, Atrial Fibrillation, Thromboembolism, Anticoagulants, Cohort Studies, Child, Female, Stroke |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 09 Oct 2023 13:56 |
| Last Modified: | 09 Oct 2023 13:56 |
| DOI: | 10.1001/jamanetworkopen.2022.13945 |
| Open Access URL: | https://jamanetwork.com/journals/jamanetworkopen/f... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3173557 |
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