Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism
Authors: Bikdeli Behnood , Jiménez David , del Toro Jorge , Piazza Gregory , Rivas Agustina , Fernández‐Reyes José Luis , Sampériz Ángel , Otero Remedios , Suriñach José María , Siniscalchi Carmine , Martín‐Guerra Javier Miguel , Castro Joaquín , Muriel Alfonso , Lip Gregory Y. H. , Goldhaber Samuel Z. , Monreal Manuel , Monreal Manuel , Prandoni Paolo , Brenner Benjamin , Farge‐Bancel Dominique , Barba Raquel , Di Micco Pierpaolo , Bertoletti Laurent , Schellong Sebastian , Tzoran Inna , Reis Abilio , Bosevski Marijan , Bounameaux Henri , Malý Radovan , Verhamme Peter , Caprini Joseph A. , Bui Hanh My , Adarraga María Dolores , Agud María , Aibar Jesús , Aibar Miguel Ángel , Amado Cristina , Arcelus Juan Ignacio , Baeza Carlos , Ballaz Aitor , Barba Raquel , Barbagelata Cristina , Barrón Manuel , Barrón‐Andrés Belén , Blanco‐Molina Ángeles , Botella Ernesto , Camon Ana María , Cañas Inmaculada , Casado Ignacio , Castro Joaquín , Chasco Leyre , Criado Juan , de Ancos Cristina , de Miguel Javier , del Toro Jorge , Demelo‐Rodríguez Pablo , Díaz‐Peromingo José Antonio , Di Campli Mario Virgilio , Díez‐Sierra Javier , Domínguez Irene Milagros , Escribano José Carlos , Falgá Conxita , Farfán‐Sedano Ana Isabel , Fernández‐Capitán Carmen , Fernández‐Reyes Jose Luis , Fidalgo María Ángeles , Flores Katia , Font Carme , Font Llorenç , Francisco Iria , Gabara Cristina , Galeano‐Valle Francisco , Galindo David , García María Angelina , García‐Bragado Ferrán , García de Herreros Marta , García‐Hernáez Raquel , García‐Mullor María Mar , García‐Raso Arantxa , Gavín‐Sebastián Olga , Gil‐Díaz Aida , Gómez‐Cuervo Covadonga , Grau Enric , Guirado Leticia , Gutiérrez Javier , Hernández‐Blasco Luis , Hernando Elena , Herreros Miguel , Jara‐Palomares Luis , Jaras María Jesús , Jiménez David , Jiménez Rafael , Joya Maria Dolores , León José Manuel , Lima Jorge , Llamas Pilar , Lobo José Luis , López‐Jiménez Luciano , López‐Miguel Patricia , López‐Núñez Juan José , López‐Reyes Raquel , López‐Ruiz Antonio , López‐Sáez Juan Bosco , Lorenzo Alicia , Madridano Olga , Maestre Ana , Marchena Pablo Javier , Martín del Pozo Mar , Martín‐Guerra Javier Miguel , Martín‐Martos Francisco , Mella Carmen , Mellado Meritxell , Mercado Maria Isabel , Moisés Jorge , Monreal Manuel , del Valle Morales María , Muñoz‐Blanco Arturo , Muñoz‐Rivas Nuria , Navas María Sierra , Nieto Jose Antonio , Núñez‐Fernández Manuel Jesús , Obispo Berta , Olid Mónica , Olivares María Carmen , Orcastegui José Luis , Ortega‐Michel Clara , Osorio Jeisson , Otalora Sonia , Otero Remedios , Parra Pedro , Parra Virginia , Pedrajas José María , Pellejero Galadriel , Porras José Antonio , Portillo José , Riera‐Mestre Antoni , Rivas Agustina , Rivera‐Civico Francisco , Rodríguez‐Chiaradía Diego Agustín , Rodríguez‐Cobo Ana , Rodríguez‐Matute Consolación , Rogado Jacobo , Roig Sonia , Rosa Vladimir , Ruiz‐Artacho Pedro , Ruiz‐Giménez Nuria , Ruiz‐Ruiz Justo , Ruiz‐Sada Pablo , Salgueiro Giorgina , Sánchez‐Martínez Rosario , Sánchez‐Muñoz‐Torrero Juan Francisco , Sancho Teresa , Sirisi Merçe , Soler Silvia , Suriñach José María , Tirado Raimundo , Torres María Isabel , Tolosa Carles , Trujillo‐Santos Javier , Uresandi Fernando , Valero Beatriz , Valle Reina , Vela Jerónimo Ramón , Vidal Gemma , Villares Paula , Zamora Carles , Gutiérrez Paula , Vázquez Fernando Javier , Engelen Matthias , Vanassche Thomas , Verhamme Peter , Hirmerova Jana , Malý Radovan , Salgado Estuardo , Ait Abdallah Nassim , Bertoletti Laurent , Bura‐Riviere Alessandra , Crichi Benjamin , Debourdeau Philippe , Olivier Espitia , Falvo Nicolas , Farge‐Bancel Dominique , Galliazzo Silvia , Helfer Hélène , Mahé Isabelle , Moustafa Farès , Poenou Geraldine , Schellong Sebastian , Braester Andrei , Brenner Benjamin , Tzoran Inna , Bilora Franca , Bucherini Eugenio , Ciammaichella Maurizio , Di Micco Pierpaolo , Imbalzano Egidio , Maida Rosa , Mastroiacovo Daniela , Pace Federica , Pesavento Raffaele , Pomero Fulvio , Prandoni Paolo , Quintavalla Roberto , Rocci Anna , Romualdi Roberta , Siniscalchi Carmine , Tufano Antonella , Visonà Adriana , Zalunardo Beniamino , Gibietis Valdis , Kigitovica Dana , Skride Andris , Fonseca Samuel , Martins Filipa , Meireles Jose , Bosevski Marijan , Bounameaux Henri , Mazzolai Lucia , Bikdeli Behnood , Caprini Joseph A. , Tafur Alfonso J. , Ochoa‐Chaar Cassius Iyad , Weinberg Ido , Wilkins Hannah , Bui Hanh My 
Published: August 2021

Background
Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF.

Methods and Results
Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90‐day and 1‐year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90‐day all‐cause (odds ratio [OR], 2.81; 95% CI, 2.33–3.38) and PE‐related mortality (OR, 2.38; 95% CI, 1.37–4.14) and increased 1‐year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10–9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all‐cause mortality (OR, 1.91; 95% CI, 1.57–2.32) but not PE‐related mortality (OR, 1.50; 95% CI, 0.85–2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90‐day all‐cause (OR, 2.28; 95% CI, 1.75–2.97) and PE‐related (OR, 3.64; 95% CI, 2.01–6.59) mortality but not stroke. Findings were similar in multivariable analyses.

Conclusions
In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.