Atrial fibrillation burden and the risk of stroke: A systematic review and dose-response meta-analysis
Shengyi Yang, Min Huang, Ai-Lian Wang, Ge Ge, Ma Mi, Hong Zhi, Lina Wang
Abstract
BACKGROUND: The increased stroke risk associated with atrial fibrillation (AF) burden exceeding 5 min is a matter of debate. In addition, the potential linear or nonlinear relationship between AF burden and stroke risk has been largely unexplored. AIM: To determine the association between AF burden > 5 min and the increased risk of stroke and explore the potential dose-response relationship between these two factors. METHODS: Sixteen studies from six databases with 53141 subjects (mean age 65 years) were included. Fifteen studies were observational studies, and one was a randomized controlled trial study. The potential nonlinear dose-response association was characterized using a restricted cubic splines regression model. AF burden for each 1 h and 2 h was associated with an increased risk of stroke. Trial sequential analysis with a random-effect model was used to evaluate the robustness of the evidence from the included 16 studies. RESULTS: = 0.656, RR = 1.02, 95%CI: 1.01-1.03). Trial sequential analysis provided robust evidence of the association between AF burden > 5 min and an increased risk of stroke. CONCLUSION: AF burden was a significant risk factor for clinical AF and future stroke. A significant linear association was documented between increased AF burden and risk of future stroke.