Factors associated with mortality in patients with atrial fibrillation: an umbrella review of systematic reviews and meta-analyses
- 1Department of Cardiology, Changhai Hospital, Naval Medical University
Abstract
Background: This study synthesized published meta-analyses to assess the quality, bias, and strength of evidence regarding mortality risk factors in patients with atrial fibrillation (AF).
Methods: Web of Science, Embase, PubMed, and Cochrane database were used to search the literature up to May 2025. Eligible studies were systematic reviews or meta-analyses investigating AF-related mortality risk factors. AMSTAR tool was used to assess methodological quality and GRADE was used to evaluate evidence certainty.
Results: A total of 216 risk factors were identified. Among them, 86 showed significant associations with mortality, while 130 did not. Based on GRADE ratings, 11 were high-quality significant factors, and 9 were of moderate-quality. Factors linked to increased mortality included certain medications (digoxin, dronedarone, sotalol; warfarin/VKA vs. NOAC was associated with higher mortality), comorbidities (cancer, COPD, diabetes, anemia, frailty, LVH, peripheral artery disease), demographic characteristics (older age, smoking, BMI <18.5, Latin American ethnicity), and AF subtype (persistent or non-paroxysmal). In contrast, reduced mortality was associated with NOAC or DOAC use, higher BMI (25–30 or ≥30), surgical interventions (catheter ablation, LAAC/LAAO), other medications (SGLT2 inhibitors, statins), and early rhythm control.
Conclusion: This review highlights key factors associated with mortality in AF. Increased risk was observed with warfarin/VKA use (vs. NOAC), certain antiarrhythmic drugs, comorbidities, low BMI, older age, smoking, and non-paroxysmal AF. In contrast, NOAC use, surgical interventions, high BMI, statin and SGLT2 inhibitor therapy, and early rhythm-control strategies were linked to reduced mortality risk.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024533372 , PROSPERO CRD42024533372
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BibTeX
@article{luo2026factors,
title = {{Factors associated with mortality in patients with atrial fibrillation: an umbrella review of systematic reviews and meta-analyses}},
author = {Jin Luo and Yunpu Niu and Ming Ni and Jingyu Zhang and Zhifu Guo},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1877770},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1877770/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Factors associated with mortality in patients with atrial fibrillation: an umbrella review of systematic reviews and meta-analyses
AU - Jin Luo
AU - Yunpu Niu
AU - Ming Ni
AU - Jingyu Zhang
AU - Zhifu Guo
PY - 2026
DA - 2026/10/13
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1877770
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1877770/full
AB - Background: This study synthesized published meta-analyses to assess the quality, bias, and strength of evidence regarding mortality risk factors in patients with atrial fibrillation (AF). Methods: Web of Science, Embase, PubMed, and Cochrane database were used to search the literature up to May 2025. Eligible studies were systematic reviews or meta-analyses investigating AF-related mortality risk factors. AMSTAR tool was used to assess methodological quality and GRADE was used to evaluate evidence certainty. Results: A total of 216 risk factors were identified. Among them, 86 showed significant associations with mortality, while 130 did not. Based on GRADE ratings, 11 were high-quality significant factors, and 9 were of moderate-quality. Factors linked to increased mortality included certain medications (digoxin, dronedarone, sotalol; warfarin/VKA vs. NOAC was associated with higher mortality), comorbidities (cancer, COPD, diabetes, anemia, frailty, LVH, peripheral artery disease), demographic characteristics (older age, smoking, BMI <18.5, Latin American ethnicity), and AF subtype (persistent or non-paroxysmal). In contrast, reduced mortality was associated with NOAC or DOAC use, higher BMI (25–30 or ≥30), surgical interventions (catheter ablation, LAAC/LAAO), other medications (SGLT2 inhibitors, statins), and early rhythm control. Conclusion: This review highlights key factors associated with mortality in AF. Increased risk was observed with warfarin/VKA use (vs. NOAC), certain antiarrhythmic drugs, comorbidities, low BMI, older age, smoking, and non-paroxysmal AF. In contrast, NOAC use, surgical interventions, high BMI, statin and SGLT2 inhibitor therapy, and early rhythm-control strategies were linked to reduced mortality risk. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024533372 , PROSPERO CRD42024533372
SN - 2297-055X
ER -