Prevalence and Clinical Impact of Atrial Fibrillation in Patients With Pulmonary Embolism

Yifeng Yang, MD; Baoqiong Liu, MD, PhD; John Taylor, DO; ZhiHua Huang, MD; Sonali Gupta, MD; Soumya Thumma, MD; LingLing Wu, MD; Shuai Wang, MD; George Everett, MD


South Med J. 2020;113(2):93-97. 

In This Article

Abstract and Introduction


Objectives: Atrial fibrillation (AF) has been suggested as a cause for pulmonary embolism (PE). We aimed to explore the prevalence and clinical impact of AF in patients with PE.

Methods: Using the 2012–2014 National (Nationwide) Inpatient Sample database, we identified "adult patients with PE" as the principal discharge diagnosis. The identified admissions were stratified into two cohorts based on the presence or absence of AF. We used multivariable regression models to evaluate in-hospital mortality, length of stay, nonhome discharge, and in-hospital complications.

Results: The prevalence of AF among the 201,360 patients with PE was 11.62%. Patients with AF were more likely to have massive PE (odds ratio 1.59, 95% confidence interval 1.4–1.81, P < 0.001), with higher mortality (adjusted odds ratio 1.48, 95% confidence interval 1.27–1.71, P < 0.001) and a greater risk of mechanical ventilation, cardiac arrest, and nonhome discharges. The length of hospital stay in patients with PE and comorbid AF was significantly longer than those without (6.24 ± 0.10 vs 4.79 ± 0.03 days).

Conclusions: AF is associated with a higher rate of massive PE, higher in-hospital mortality, a longer length of hospital stay, and a higher incidence of in-hospital complications and nonhome discharge.


Acute pulmonary embolism (PE) is a common and potentially fatal disease. It is associated with an in-hospital mortality of 2% to 3%[1,2] and a cumulative rate of overall mortality of 8.6% to 12.5% at 3 months.[3,4] Atrial fibrillation (AF) is the most common type of significant cardiac arrhythmia. It afflicts up to 37% of people aged 55 years and older during their lifetime.[5] AF can cause PE by leading to thrombus formation in the right cardiac chamber.[6–8] In a retrospective cohort study of 270 patients admitted with PE, AF was associated with 1- and 6-month all-cause mortality prediction, but it did not increase risk for intrahospital mortality.[9] To date, large-scale data regarding the prognostic role of AF in patients with acute PE remain limited. The association of AF with in-hospital outcomes and massive PE is unclear.

The aims of our study were to assess the prevalence of AF in patients with confirmed acute PE; to determine the association of AF with massive PE and in-hospital complications, including cardiac arrest and mechanical ventilation; and to assess the association of AF with the outcomes (in-hospital mortality, length of stay, and nonhome discharge) of patients with PE.