Evidence map›Paper›PMID 41603358›Full record

SynthesisEuropean heart journal2026

Non-antiarrhythmic pharmacotherapy in cardio-renal-metabolic disease and incident atrial fibrillation: a trial meta-analysis.

Keerthenan Raveendra, Ramesh Nadarajah, Harriet Larvin, Maryum Farooq, Mohammad Haris, Uther Cutting, Jing Kang, Chris Wilkinson, Mayank Dalakoti, Dipak Kotecha and 6 more

Abstract readMeta-Analysis
In one paragraph

Synthesis in European heart journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Keerthenan RaveendraFaculty of Medicine and Health, University of Leeds, Leeds, UK.ORCID 0000-0001-8766-9433
Ramesh NadarajahLeeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.ORCID 0000-0001-9895-9356
Harriet LarvinWolfson Institute of Population Health, Queen Mary University of London, London, UK.ORCID 0000-0001-7263-4182
Maryum FarooqDepartment of Cardiology, Calderdale and Huddersfield NHS Trust, Huddersfield, UK.
Mohammad HarisLeeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Uther CuttingFaculty of Medicine and Health, University of Leeds, Leeds, UK.
Jing KangOral Clinical Research Unit, Faculty of Dentistry Oral Craniofacial Sciences, King's College London, London, UK.
Chris WilkinsonHull York Medical School, University of York, York, UK.
Mayank DalakotiNational University Heart Centre, National University Hospital, Singapore, Singapore.
Dipak KotechaInstitute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.ORCID 0000-0002-2570-9812
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.ORCID 0000-0002-7566-1626
Giuseppe BorianiCardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy.ORCID 0000-0002-9820-4815
Alan John CammMolecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
Isabelle C Van GelderDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jianhua WuWolfson Institute of Population Health, Queen Mary University of London, London, UK.ORCID 0000-0001-6093-599X
Chris P GaleFaculty of Medicine and Health, University of Leeds, Leeds, UK.ORCID 0000-0003-4732-382X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsAtrial fibrillation (AF) disease burden is increasing. Pharmacotherapy of cardio-renal-metabolic diseases may prevent incident AF. This meta-analysis estimates the effect of different pharmacotherapies on risk of incident AF across cardio-renal-metabolic diseases.

methodsThe Medline, Embase, and Cochrane Central databases were searched to 7 October 2025 for randomized clinical trials (RCTs) comparing the effect of a non-antiarrhythmic cardio-renal-metabolic medication with control or another agent for incident AF. Random-effects meta-analysis using the Mantel-Haenszel method, with between-study variance estimated using the DerSimonian-Laird method, was performed to synthesize risk ratios (RR) with 95% confidence intervals (CI).

resultsTwo hundred and forty-nine RCTs involving 745 041 patients were included, of which 207 identified AF through adverse event reports, 161 were placebo-controlled, and 15 had AF as a pre-specified endpoint. In placebo-controlled trials, significant differences in incident AF were observed with treatment of heart failure with reduced ejection fraction with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (RR 0.69, 95% CI 0.60-0.80), mineralocorticoid receptor antagonists (RR 0.62, 95% CI 0.43-0.90), and sodium-glucose co-transporter 2 (SGLT2) inhibitors (RR 0.62, 95% CI 0.44-0.87); treatment of chronic kidney disease with SGLT2 inhibitors (RR 0.53, 95% CI 0.33-0.85); and treatment of obesity with glucagon-like peptide-1 receptor agonists (RR 0.79, 95% CI 0.63-0.99). However, the number of AF events per trial was low and none were adequately powered for incident AF.

conclusionsProspective RCTs with AF as a pre-specified outcome should be integrated into the design of future trials of cardio-renal-metabolic medications to determine whether they reduce incident AF.

Indexed as

Atrial FibrillationAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHeart FailureHumansRandomized Controlled Trials as TopicAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAtrial fibrillationCardio-renal-metabolicMeta-analysisPharmacotherapyPrimary prevention

Identifiers

PMID41603358
PMCPMC13268693

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.