Arrhythmias & electrophysiology
Risk and protective factors for stroke and transient ischaemic attack in patients with atrial fibrillation: an umbrella review of meta-analyses
Authors' conclusion
Despite stroke being the most severe complication of AF, this umbrella review reveals that few risk factors are supported by high-level evidence. Our findings confirm that elevated NT-proBNP, age and prior stroke are credible stroke risk factors in patients with AF. However, risk factors with weaker evidence, such as hypertension and vascular disease, require further investigation to clarify their actual impact. PROSPERO registration number CRD42023471263.
Study context
- Population
- Patients with atrial fibrillation (AF)participants, 35 studies included (23 meta-analyses of observational studies, 22 meta-analyses of randomised controlled trials (RCTs)) · meta-analyses of observational studies 23 · meta-analyses of RCTs 22
- Participants
- over 7,276,000 patients
- Comparison
- Association of protective and risk factors with stroke and transient ischaemic attack (TIA) in patients with AF
- Outcome
- Stroke risk factors among observational studies
Pooled result
As reported in the abstract
- High levels of N-terminal pro-brain Natriuretic Peptide (NT-proBNP): convincing evidence of stroke risk
- Previous stroke/TIA and age (65-74 years): highly suggestive level of evidence
- Graded with the Ioannidis framework
Further pooled results
Non-randomised risk factors in meta-analyses of RCTs
- Female sex, kidney failure, non-paroxysmal AF and type 2 diabetes mellitus: risk factors with moderate to high evidence
- Hypertension and vascular disease associated with stroke, weak level of evidence
- Assessed with GRADE
Associations assessed
- Associations from meta-analyses of observational studies
- 45
- Associations from meta-analyses of RCTs
- 24
Original publication
Risk and protective factors for stroke and transient ischaemic attack in patients with atrial fibrillation: an umbrella review of meta-analyses. Heart. Published 7 October 2025. doi:10.
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