Figure 1
Meta-analysis of the prevalence of atrial fibrillation in rheumatic heart disease by WHO region.
Figure 2
Meta-analysis of the incidence of atrial fibrillation in rheumatic heart disease.
Table 1
Meta-analysis of the prevalence of atrial fibrillation in the global population with rheumatic heart disease.
| Prevalence, % | 95% Confidence interval | N Studies | N Participants | Heterogeneity | P Egger test | P value comparison | Meta-regression | |||
|---|---|---|---|---|---|---|---|---|---|---|
| I2, % | P value | R2, % | P value for testing of moderators | |||||||
| Global | 32.8 | 28.1–37.7 | 69 | 43,059 | 99.0 | <0.0001 | <0.0001 | – | – | |
| · Low risk of bias studies | 34.7 | 25.3–44.8 | 20 | 4,819 | 98.0 | < 0.0001 | 0.257 | – | – | |
| By WHO region | 50.4 | <0.0001 | ||||||||
| · Europe | 50.1 | 43.1–57.1 | 16 | 8,503 | 97.3 | <0.0001 | 0.010 | <0.0001 | ||
| · Western Pacific | 45.9 | 36.9–55.1 | 11 | 3,880 | 96.4 | <0.0001 | 0.467 | |||
| · Eastern Mediterranean | 33.6 | 23.0–45.2 | 10 | 2,361 | 96.6 | <0.0001 | 0.863 | |||
| · Americas | 25.1 | 13.6–38.8 | 6 | 644 | 92.7 | <0.0001 | 0.127 | |||
| · South-East Asia | 22.9 | 17.1–29.3 | 18 | 22,461 | 98.9 | <0.0001 | 0.001 | |||
| · Africa | 12.6 | 8.5–17.5 | 7 | 1,867 | 87.9 | <0.0001 | 0.703 | |||
| By level of human development index | 57.6 | <0.0001 | ||||||||
| · Very high | 45.4 | 38.7–52.3 | 18 | 10,498 | 97.8 | <0.0001 | 0.120 | <0.0001 | ||
| · High | 41.9 | 35.5–48.3 | 22 | 5,032 | 95.0 | <0.0001 | 0.760 | |||
| · Medium | 21.1 | 16.6–26.0 | 23 | 26,006 | 98.5 | <0.0001 | 0.015 | |||
| · Low | 13.2 | 8.2–19.4 | 6 | 1,523 | 89.8 | <0.0001 | 0.092 | |||
| By endemic status | 24.5 | 0.0001 | ||||||||
| · Endemic area | 22.8 | 18.5–27.3 | 33 | 28,605 | 98.5 | <0.0001 | 0.002 | <0.0001 | ||
| · Non-endemic area | 42.8 | 38.1–47.6 | 36 | 14,454 | 96.8 | <0.0001 | 0.205 | |||
| By surgery valvular intervention status | 3.9 | 0.025 | ||||||||
| · Before valvular intervention | 28.4 | 22.7–34.4 | 40 | 27,690 | 99.0 | <0.0001 | 0.0005 | 0.026 | ||
| · After valvular intervention | 39.3 | 31.8–47.0 | 29 | 15,369 | 98.8 | <0.0001 | 0.008 | |||
| Type of valvular interventions | ||||||||||
| - Valve replacement | 60.3 | 48.6–71.5 | 4 | 603 | 87.0 | <0.0001 | 0.701 | 0.0001 | ||
| - Valvuloplasty | 39.5 | 30.6–48.8 | 10 | 3,122 | 95.7 | <0.0001 | 0.503 | |||
| - Valvulotomy | 28.2 | 19.8–37.3 | 11 | 9,467 | 98.5 | <0.0001 | 0.107 | |||
| By age group | 35.0 | <0.0001 | ||||||||
| · Children and adolescents | 7.6 | 1.9–16.8 | 2 | 496 | 87.8 | 0.004 | NA | <0.0001 | ||
| · Children, adolescents, and adults | 20.5 | 14.2–27.5 | 15 | 23,609 | 99.2 | <0.0001 | 0.073 | |||
| · Adolescents and adults | 26.2 | 17.3–36.3 | 6 | 1,774 | 94.2 | <0.0001 | 0.027 | |||
| · Adults | 39.7 | 34.4–45.1 | 46 | 17,180 | 98.0 | <0.0001 | 0.021 | |||
| By study period | 7.0 | 0.026 | ||||||||
| · Before 2000 | 38.2 | 30.2–46.5 | 35 | 27,825 | 99.4 | <0.0001 | < 0.0001 | 0.022 | ||
| · 2000 or after | 27.3 | 22.7–32.2 | 34 | 15,234 | 97.4 | <0.0001 | 0.196 | |||
[i] R2: amount of heterogeneity accounted for; NA: not applicable.
Table 2
Meta-analysis of the prevalence of atrial fibrillation in the global population with rheumatic heart disease according to clinical presentation.
| Prevalence, % | 95% Confidence interval | N Studies | N Participants | Heterogeneity | P Egger test | P value comparison | ||
|---|---|---|---|---|---|---|---|---|
| I2, % | P value | |||||||
| Severity overall | ||||||||
| · Severe valvular disease | 30.8 | 24.0–38.2 | 32 | 14,049 | 98.6 | <0.0001 | 0.027 | 0.009 |
| · Moderate/mild valvular disease | 20.7 | 17.1–24.6 | 1 | 454 | NA | NA | NA | |
| Severe valvular disease by valve | ||||||||
| · Severe mitral disease | 30.4 | 23.6–37.6 | 18 | 3,627 | 94.7 | <0.0001 | 0.165 | 0.038 |
| · Severe aortic disease | 6.3 | 0.0–26.9 | 2 | 39 | 60.5 | 0.112 | NA | |
| Mitral valve disease | ||||||||
| · Mixed mitral disease | 65.6 | 42.5–85.4 | 4 | 449 | 94.7 | <0.0001 | 0.461 | 0.011 |
| · Mitral stenosis | 33.9 | 28.5–39.4 | 42 | 17,221 | 98.1 | <0.0001 | 0.005 | |
| · Mitral regurgitation | 21.6 | 7.8–39.7 | 6 | 880 | 96.6 | <0.0001 | 0.528 | |
| Aortic valve disease | ||||||||
| · Mixed aortic disease | 3.6 | 0.8–8.1 | 1 | 110 | NA | NA | NA | 0.694 |
| · Aortic stenosis | 5.0 | 0.0–20.2 | 1 | 20 | NA | NA | NA | |
| · Aortic regurgitation | 5.8 | 0.6–14.4 | 3 | 180 | 58.3 | 0.091 | 0.398 | |
[i] NA: not applicable.
Figure 3
Panel A. Comparison of mean age between RHD patients with and without AF; Panel B. Comparison of tricuspid valve involvement between RHD patients with and without AF; Panel C. Comparison of previous cerebrovascular event* between RHD patients with and without AF; Panel D. Comparison of advanced heart failure** between RHD patients with and without AF; Panel E. Highly sensitive C reactive protein concentration (mg/dL).
Figure 4
Panel A. Comparison of systolic pulmonary artery pressure between RHD patients with and without AF; Panel B. Comparison of right atrium pressure between RHD patients with and without AF; Panel C. Comparison of left atrium diameter between RHD patients with and without AF; Panel D. Comparison of left ventricle ejection fraction between RHD patients with and without AF.