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Life sciences · Review
Frontiers in Cardiovascular Medicine · October 13, 2026
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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