New-onset atrial fibrillation in patients with community-acquired pneumonia: a systematic review and meta-analysis

Community-acquired pneumonia (CAP) is the commonest lower respiratory tract infection, often complicated by cardiovascular events and cardiac arrythmias, such as new-onset Atrial Fibrillation (noAF). NoAF, a new or first detactable episode of a chaotic and irregular atrial rhythm, has been associated with increased mortality in CAP patients, especially in critically-ill ones. However, the prevalence of noAF in patients with CAP is still unclear.

We aimed to estimate the pooled prevalence of noAF in patients with CAP through a systematic review and meta-analysis of the literature.

PubMed and EMBASE were systematically searched from inception to 27th January 2022. All studies reporting the prevalence of noAF in CAP patients were included. The pooled prevalence of noAF, 95% Confidence Intervals (CI) and 95% Prediction Intervals (PI), were computed using generalized linear mixed models. The inconsistency index (I²) was calculated to measure heterogeneity. Subgroup analyses according to the study design and the geographical location were also performed. A protocol for this study was registered on PROSPERO (CRD42022307422).

We retrieved 4,947 records from the literature search, with 11 studies were finally included, with a total of 346,192 CAP patients; 5 (45%) studies were conducted in Europe, while 4 (36%) were prospective studies. Pooled prevalence of noAF in CAP population was 6.6% (95% CI 4.1–10.6, 95% PI 1.0–33.6, I²=99%) [Figure 1]. No significant difference according to geographical location of the included studies or study design was found at subgroup analyses.

NoAF is common in CAP patients, being found in 1 out of 15 patients with CAP, with the 95% PI pointing towards potential higher prevalence in specific clinical scenarios. No significant subgroup differences were observed according to study design and geographical location.

Type of funding sources: None.