Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
JAMA Netw Open. 2022 May 2;5(5):e2213945. doi: 10.1001/jamanetworkopen.2022.13945.
New-onset atrial fibrillation (AF) is commonly reported in patients with severe infections. However, the absolute risk of thromboembolic events without anticoagulation remains unknown.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
New-onset AF.
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.
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.
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.
新发生的心房颤动（AF）在患有严重感染的患者中很常见。然而，没有抗凝治疗的情况下发生血栓栓塞事件的绝对风险尚不清楚。
研究肺炎患者中 AF 相关的血栓栓塞风险，评估复发性 AF 的风险，并研究开始抗凝治疗与新发 AF 的关系。
设计、地点和参与者：这项基于人群的队列研究使用了丹麦全国性的注册数据库。参与者包括丹麦 1998 年至 2018 年期间因社区获得性肺炎住院的患者。统计分析于 2021 年 8 月 15 日至 2022 年 3 月 12 日进行。
新发 AF。
未抗凝治疗的血栓栓塞事件、复发性 AF 和全因死亡。在 1 年和 3 年的随访中，计算了新发 AF 患者无抗凝治疗、新出现 AF 的医院或门诊接触、开始抗凝治疗和全因死亡的血栓栓塞风险。死亡被视为竞争风险，如果患者因 AF 而开始抗凝治疗，则使用逆概率删失权重来考虑患者的删失。
在 274196 例因社区获得性肺炎住院的患者中，6553 例（平均年龄[标准差]，79.1[11.0]岁；3405 例女性[52.0%]）新发 AF。无 AF 的患者 1 年血栓栓塞风险为 0.8%（95%CI，0.8%-0.8%），新发 AF 且未抗凝的患者为 2.1%（95%CI，1.8%-2.5%）；AF 且中等卒中风险的患者为 1.4%（95%CI，1.0%-2.0%），AF 且高卒中风险的患者为 2.8%（95%CI，2.3%-3.4%）。3 年风险分别为中等卒中风险患者 3.5%（95%CI，2.8%-4.3%）和高卒中风险患者 5.3%（95%CI，4.4%-6.5%）。新发 AF 的患者中，32.9%（95%CI，31.8%-34.1%）有新的 AF 医院接触，14.0%（95%CI，13.2%-14.9%）在 AF 诊断后的 3 年内开始抗凝治疗。3 年时，无 AF 的肺炎患者全因死亡率为 25.7%（95%CI，25.6%-25.9%），新发 AF 的患者为 49.8%（95%CI，48.6%-51.1%）。
这项队列研究发现，社区获得性肺炎后新发 AF 与血栓栓塞风险增加相关，可能需要抗凝治疗。大约三分之一的患者在 3 年的随访中因 AF 有新的医院或门诊接触，这表明急性感染引起的 AF 不是一种短暂的、自行终止的疾病，不会随着感染的消退而逆转。
