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Thromboembolic Risk in Patients With Pneumonia and New-Onset AF
Quick Takes
- A large Danish cohort database of patients hospitalized for pneumonia showed that the 1-year risk of thromboembolism was 0.8% in patients without atrial fibrillation (AF) vs. 2.1% in patients with AF.
- Approximately one-third of patients had a new hospital or outpatient clinic contact for AF during the 3-year follow-up, suggesting that patients diagnosed with pneumonia and AF may warrant long-term anticoagulation therapy.
Study Questions:
What is the risk of thromboembolism and recurrent atrial fibrillation (AF) after pneumonia-related AF?
Methods:
The authors used linked nationwide registries provided by the Danish Health Data Authority. Participants included patients hospitalized with community-acquired pneumonia from 1998–2018.
Results:
Among 274,196 patients hospitalized for pneumonia, 6,553 patients developed new-onset AF (mean age, 79 years). The 1-year risk of arterial thromboembolism was 0.8% in patients without AF versus 2.1% in patients with new-onset AF without anticoagulation. Three-year risks were 3.5% among patients with intermediate stroke risk and 5.3% among patients with high stroke risk. Among patients with new-onset AF, 33% had a new contact with AF, and 14% initiated anticoagulation during the 3 years after incident AF diagnosis. At 3 years, the all-cause mortality rate was 26% in patients with pneumonia without AF and 50% in patients with new-onset AF.
Conclusions:
The authors concluded that new-onset AF occurring in the setting of community acquired pneumonia was associated with an increased risk of thromboembolism, which may warrant anticoagulation therapy.
Perspective:
New-onset AF is not uncommon in patients hospitalized with pneumonia (5-10%). It has been previously hypothesized that AF triggered by acute infection is a transitory and reversible condition, and that long-term anticoagulation may not be necessary. The guidelines do not provide recommendations regarding the role of anticoagulant therapy to mitigate risk of stroke. The present study shows that patients with AF diagnosed in the setting of pneumonia have a high risk of AF recurrence and thromboembolism. Approximately one-third of patients had a new hospital or outpatient clinic contact for AF during the 3-year follow-up. Patients with moderate or greater risk of stroke based on CHA2DS2-VASc score should be considered for anticoagulation.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Geriatric Cardiology, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Ambulatory Care Facilities, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Geriatrics, Pneumonia, Risk Assessment, Secondary Prevention, Stroke, Thromboembolism, Vascular Diseases
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