Effect of Multifactorial Risk Factor Interventions on Atrial Fibrillation: A Systematic Review and Meta- Analysis

Evidence supports the benefit of managing atrial fibrillation (AF) specific risk factors in second-ary prevention of AF. However, a comprehensive sum-mary of the effect of multifactorial risk factor interventions on outcomes of patients with AF over long-term is lacking. We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL data-bases from inception to October 2021 for both ran-domized controlled trials (RCT) and observational studies comparing multifactorial risk factor interven-tions to usual care in patients with AF. Fifteen studies (10 RCT, 5 observational) with 3786 patients were included (mean age 63.8 years, 64.0% males). Follow-up ranged from 3 to 42 months. We found no signifi-cant effects of multifactorial risk factor interventions on AF recurrence [pooled relative risk (RR): 0.93, 95% CI: 0.74-1.16, P = 0.51, I2 = 54%], AF-related rehospitalization at 12 months (RR: 0.69, 95% CI: 0.43-1.11, P= 0.13, I2 = 0%), cardiovascular rehospital-ization at 12 months (RR: 0.76, 95% CI: 0.53-1.09, P= 0.13, I2 = 53%), or AF-related adverse events at 12 and 15 months. However, multifactorial interventions were associated with reduced AF-related symptoms and improved health-related quality of life (HRQoL) at all studied time points. Current evidence does not support consistent associations between multifactorial risk factor interventions and AF recurrence after rhythm control therapy or AF-related or cardiovascular hospitalization in patients with AF. However, these interventions are associated with clinically relevant improvement in AF-related symptoms and HRQoL. Additional randomized studies are required to evalu-ate the impact of multifactorial risk factor interven-tions on patient-centered health outcomes. (Curr Probl Cardiol 2023;48:101572.)