Author (year) | Title | Objectives | Studies included | Trials (n) | Patients (n) | Primary outcomes | Types of participants | Types of interventions |
---|---|---|---|---|---|---|---|---|
Huffman et al. [33] | Concomitant atrial fibrillation surgery for people undergoing cardiac surgery | To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery. | RCTs evaluating the effect of any concomitant AF surgery compared with no AF surgery | 22 | 1899 | All-cause mortality, freedom from AF, flutter, or tachycardia. Procedural safety (adverse events) | Adults with pre-operative AF, undergoing cardiac surgery for another indication | Any concomitant AF surgery |
Aguilar et al. [26] | Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular AF and no history of stroke or TIA | To characterize relative effect of long-term OAC treatment compared with antiplatelet therapy on major vascular events in patients with non-valvular AF and no history of stroke/TIA. | RCTs in which long-term adjusted-dose OAC was compared with antiplatelet therapy in patients with chronic non-valvular AF. | 8 | 9598 | All strokes (ischemic and hemorrhagic) | Non-valvular AF patients, most without previous stroke or TIA | Oral anticoagulation by vitamin K antagonists |
Aguilar and Hart [24] | Oral anticoagulants for preventing stroke in patients with non-valvular AF and no previous history of stroke or TIA | To characterize the efficacy and safety of OAC for the primary prevention of stroke in patients with chronic AF. | RCTs comparing OACs with control in patients with chronic non-valvular atrial fibrillation and no history of TIA/stroke. | 5 | 2313 | All strokes (ischemic and hemorrhagic) | Non-valvular AF; most without previous stroke or TIA | Oral anticoagulants for preventing stroke in patients with non-valvular AF |
Aguilar and Hart [25] | Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or TIA | To characterize the effect of long-term antiplatelet on major vascular events in patients with non-valvular AF and no history of stroke or TIA. | RCTs in which long-term antiplatelet was compared to placebo/control in patients with chronic non-valvular AF. | 3 | 1965 | All strokes (ischemic and hemorrhagic) | Non-valvular AF without previous stroke or TIA | Aspirin or other specific platelet anti-aggregants given in any dose, formulation, combination, or frequency were considered. |
Saxena and Koudstaal [27] | Anticoagulants for preventing stroke in patients with non-rheumatic atrial fibrillation and a history of stroke or TIA | To determine the value of anticoagulant treatment for the long-term prevention of recurrent vascular events in patients with non-rheumatic AF and previous TIA or minor ischaemic stroke. | RCTs - Open-label oral anticoagulants versus control or double-blind anticoagulant treatment versus placebo. | 2 | 485 | Composite event of vascular death, nonfatal stroke, nonfatal MI or systematic embolism. | Patients with non-rheumatic AF and a previous history of TIA or minor ischaemic stroke. Only included patients without contraindications to anticoagulants. | Anticoagulation (INR 2.5-4.0 in one study). |
Saxena and Koudstaal [28] | Anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-rheumatic atrial fibrillation and a history of stroke or TIA. | To compare the value of anticoagulant and antiplatelet therapy for the long-term prevention of recurrent vascular events in patients with non-rheumatic AF. | RCTs comparing anticoagulants to antiplatelets in patients with prior TIA or stroke. | 2 | 1371 | Composite event of vascular death, nonfatal stroke, nonfatal myocardial infarction or systematic embolism. | Patients with non-rheumatic AF and a previous history of TIA or minor ischaemic stroke. Excluded patients with poorly controlled hypertension. | Anticoagulation (INR 2.5-4.0 in one study; 2.4-3.0 in the other). |
Kimachi et al. [29] | Direct OAC versus warfarin for preventing stroke and systemic embolic events among atrial fibrillation patients with chronic kidney disease | To assess the efficacy and safety of DOAC including apixaban, dabigatran, edoxaban, and rivaroxaban versus warfarin among AF patients with CKD. | RCTs and quasi-RCTs (RCTs in which treatment allocation was by predictable methods such as date of birth) comparing DOAC with warfarin. | 5 | 12,545 | Composite of all strokes and systemic embolic events. Major bleeding or symptomatic bleeding in a critical area or organ. | Eligible participants were diagnosed with non-valvular AF and moderate kidney impairment, defined as CrCl or eGFR between 15 and 60 mL/min. | DTIs including apixaban, dabigatran, edoxaban, and rivaroxaban as well as any other intervention classified as DOAC. Warfarin was to be dose-adjusted using INR. |
Lafuente-Lafuente et al. [30] | Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation | To determine in patients who have recovered sinus rhythm after having AF, the effects of long-term treatment with antiarrhythmic drugs on death, stroke, embolism, drug adverse effects and AF recurrence. | RCTs comparing any antiarrhythmic drug with a control in adults who had AF and in whom sinus rhythm was restored. | 59 | 21,305 | Mortality, Embolic complications, and adverse events. | Adults (> 16 years) who had AF of any type and duration and in whom sinus rhythm had been restored, spontaneously or by any therapeutic intervention. | Oral long-term treatment with any available antiarrhythmic drug, at an appropriate dosing regime, aimed at preventing new episodes of AF. |
Salazar et al. [31] | Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation | To assess comparative safety and efficacy of long-term anticoagulation using DTIs versus VKAs on vascular deaths and ischaemic events in people with non-valvular AF. | RCTs comparing DTIs versus VKAs for prevention of stroke and systemic embolism in people with non-valvular AF. | 8 | 27,557 | Vascular death + ischemic events, major bleeding. Composite outcome of vascular deaths and ischaemic events. Composite outcome of fatal or non-fatal major bleeding events. | People with non-valvular AF and one or more risk factors for stroke. | DTIs at standard doses compared with VKAs (adjusted-dose warfarin) for an INR between 2 and 3. |
Nyong et al. [32] | Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation | To determine the efficacy and safety of ablation (catheter and surgical) in people with non-paroxysmal AF compared to antiarrhythmic drugs. | RCTs evaluating the effect of radiofrequency catheter ablation or surgical ablation compared with antiarrhythmic drugs. | 3 | 261 | Freedom from atrial arrhythmias, or recurrence of any atrial arrhythmias. | Adult patients with persistent or long-standing persistent AF. | Radiofrequency catheter ablation technique. |
Risom et al. [34] | Exercise-based cardiac rehabilitation for adults with atrial fibrillation | To assess benefits and harms of exercise-based rehabilitation programs, alone or with another intervention, compared with no exercise training in adults who currently have AF, or have been treated for AF. | RCT that investigated exercise-based interventions compared with any type of no-exercise control. | 6 | 4 21 | Mortality, serious adverse events, health-related quality of life. | Adult patients (18 years old or older) with AF, or who have been treated for AF. | Rehabilitation program with exercise training included. Exercise-based interventions were defined as: any rehabilitation program in an inpatient, outpatient, or community- or homebased setting. |
Bruins and Berge [35] | Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with AF. | To assess the effectiveness and safety of treatment with factor Xa inhibitors versus VKAs for preventing cerebral or systemic embolic events in people with AF. | RCTs that directly compared effects of long-term treatment with Factor Xa inhibitors vs. VKAs for preventing cerebral and systemic embolism in AF patients. | 13 | 67,688 | The composite endpoint of all strokes (both ischaemic and hemorrhagic) and other systemic embolic events. | People with AF who were eligible for treatment with anticoagulants. | Treatment with an oral or parenteral factor Xa inhibitor versus oral vitamin K antagonists (warfarin and congeners) with the intensity monitored using INR. |
Moran et al. [39] | Systematic screening for the detection of atrial fibrillation | The primary objective of the review was to investigate whether evidence shows differences between systematic screening and routine practice in the detection of new cases of AF | RCTs and cluster-RCTs comparing systematic screening vs. routine practice. | 1 | 9137 | Primary outcome under investigation was the difference in the detection of new cases of AF associated with systematic screening compared with routine practice. | Men and women over the age of 40 years. | This was a diagnostic screening study so no intervention per se. Studies eligible for inclusion compared population-based, targeted or opportunistic screening program versus no screening. |
Clarkesmith et al. [36] | Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation | To evaluate the effects of educational and behavioural interventions for OAC on TTR in AF patients. | RCTs evaluating the effect of any educational and behavioral intervention compared with usual care, no intervention, or intervention in combination with other self-management techniques. | 11 | 2246 | Primary outcome measure was TTR. | Adults diagnosed with AF | All types of educational and behavioural interventions. |
Chen et al. [37] | Catheter ablation for paroxysmal and persistent atrial fibrillation | The primary objective was to assess the beneficial and harmful effects of catheter ablation in comparison with medical treatment in patients with paroxysmal and persistent AF. | RCTs in people with paroxysmal and persistent AF treated by any type of ablation method. | 7 | 3560 | Recurrence of AF, fatal and non-fatal embolic complications. All-cause mortality, death due to thrombo-embolic events. | Patients with paroxysmal and persistent AF. | Any type of catheter ablation, including pulmonary vein electrical isolation, superior vena cava isolation, left atrium posterior wall ablation and others. |
Mead et al.* [40] | Electrical cardioversion for atrial fibrillation and flutter | To assess effects of cardioversion of AF/ flutter on risk of thromboembolic events, strokes and mortality, the rate of cognitive decline, quality of life, the use of anticoagulants and risk of re-hospitalisation. | RCTs of electrical cardioversion plus ‘usual care’ vs. ‘usual care’ only. | 3 | 927 | Primary outcome: risk of stroke, peripheral embolism, and death. | Adults with paroxysmal, sustained or permanent AF or atrial flutter. | Electrical cardioversion used as a first intervention plus ‘usual care’ versus ‘usual care’ only. ‘Usual care’ included drugs for ‘rate control’, anticoagulants or antiplatelet drugs. |
Heneghan et al. [38] | Self-monitoring and self-management of oral anticoagulation | To evaluate effects on thrombotic events, major hemorrhages, and all-cause mortality of self-monitoring or self-management of oral anticoagulation compared with standard monitoring. | RCTs assessing the therapeutic effectiveness and safety of self-monitoring or self-management of oral anticoagulation therapy. | 28 | 8950 | Primary outcomes were thromboembolic events, all-cause mortality, major haemorrhage, TTR. | All patients on long-term OAC (treatment duration longer than two months), irrespective of the indication for treatment. | Self-monitoring or self-management of oral anticoagulation |