Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses.Conclusions Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease. Interventions aimed at reducing outcomes beyond stroke are warranted in patients with atrial fibrillation.IntroductionAtrial fibrillation is a leading cause of morbidity and mortality, with an estimated five million incident cases globally.1 It is increasing in prevalence in both developing and developed countries and is associated with an increased risk of all cause mortality and stroke, as well as higher medical costs and a reduced quality of life.2 3Although the prevention and management of stroke in atrial fibrillation has been the primary focus of guidelines4 and clinical trials,5 6 recent studies have suggested that it can also be associated with a range of different cardiovascular diseases, including ischaemic heart disease and chronic kidney disease.2 7 8 9 10 Individual studies, however, have provided conflicting estimates of the strength of the association between atrial fibrillation and a range of cardiovascular diseases and have not agreed on whether there are relevant associations at all, possibly because of the small sample sizes examined.11 12 13 14 Pooling all available evidence could allow for the determination of robust estimates of any associations that could inform outcome selection in future randomised controlled trials and guide public health efforts to reduce the incidence of associated cardiovascular disease.We conducted a systematic review and meta analysis of the association between atrial fibrillation and cardiovascular disease and death to determine the relative and absolute risks of death and a range of associated cardiovascular outcomes. A qualified research librarian developed the search strategy (see table A in appendix).
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