Arrhythmias & electrophysiology

Long-term cardiovascular risks after atrial fibrillation diagnosis: a systematic review and meta-analysis

HeartPublished systematic review and meta-analysis

Authors' conclusion

In patients with AF, heart failure was the most common and persistent adverse outcome. Despite improvement in stroke prevention, heart failure incidence has not declined, highlighting the need for targeted strategies and guideline focus. Further research is needed to address heart failure prevention and refine the understanding of sex-specific cardiovascular risks.

Study context

Population
Patients with atrial fibrillation (AF) in longitudinal cohort studies published from 2015 onwards80 studies, 73 studies (24,817,465 person-years of follow-up) in the primary meta-analyses of incidence rates (IRs)
Participants
5,498,857 patients
Outcome
Incidence rates of cardiovascular events
Methodological detailsrandom-effects meta-analyses, meta-regressions
  • Random-effects meta-analyses
  • Meta-regressions

Pooled result

As reported in the abstract

Heart failure IR

2.98 cases per 100 person-years, 95% CI 2.10 to 4.24

Ischaemic stroke IR

1.76 cases per 100 person-years, 95% CI 1.44 to 2.15

Cardiovascular death IR

1.66 cases per 100 person-years, 95% CI 1.24 to 2.23

Myocardial infarction

0.64 cases per 100 person-year, 95% CI 0.41 to 0.98

Further pooled results

Temporal trends in incidence (study period pre/post-2011)

Heart failure IRR
0.66, 95% CI 0.33 to 1.34
Ischaemic stroke IRR
0.56, 95% CI 0.40 to 0.80
Cardiovascular death IRR
0.52, 95% CI 0.29 to 0.93
Myocardial infarction IRR
0.27, 95% CI 0.14 to 0.49
  • Except for heart failure, study outcomes declined over time

Sex differences

Sex differences appear to have diminished over time and were not found to be statistically significant in more recent studies

Original publication

Long-term cardiovascular risks after atrial fibrillation diagnosis: a systematic review and meta-analysis. Heart. Published 17 September 2025. doi:10.1136/heartjnl-2025-326376

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