Evidence map›Paper›PMID 40383741›Full record

SynthesisDrug safety2025

Risk of New-Onset Atrial Fibrillation in Opioid Users: A Systematic Review and Meta-Analysis on 24,006,367 Participants.

Danilo Menichelli, Gianluca Gazzaniga, Arianna Pannunzio, Ilaria Maria Palumbo, Arianna Pani, Pasquale Pignatelli, Emanuele Valeriani, Daniele Pastori

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Drug safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing 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

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Review
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

8 authors.

Danilo MenichelliDepartment of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy.
Gianluca GazzanigaDepartment of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy.
Arianna PannunzioDepartment of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy.
Ilaria Maria PalumboDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00185, Rome, Italy.
Arianna PaniDepartment of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy.
Pasquale PignatelliDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00185, Rome, Italy.
Emanuele ValerianiDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00185, Rome, Italy.
Daniele PastoriDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00185, Rome, Italy. daniele.pastori@uniroma1.it.ORCID http://orcid.org/0000-0001-6357-5213

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite ongoing efforts, the prescription of opioids is still common. Long-term opioid use has been associated with an increased risk of adverse cardiovascular outcomes.

objectiveWe aimed to evaluate the association between opioid use and the risk of new-onset atrial fibrillation.

methodsWe performed a systematic review and meta-analysis of studies retrieved from MEDLINE and EMBASE databases according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines from inception to 29 January, 2024. The protocol was registered at PROSPERO (CRD42024512500). Two authors independently screened and extracted data from included studies. The quantitative analysis included only observational studies and results were synthesised by a pooled hazard ratio. Risk of bias was performed according to the ROBINS-I Cochrane tool, and the summary of evidence according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations).

resultsFour out of 782 studies met the inclusion criteria for a quantitative analysis with 24,006,367 participants. Overall, 153,734 were opioid users. The proportion of women ranged from 13.2 to 100% and the median age ranged from 34 to 65 years. Studies reported 991,263 cases of new-onset atrial fibrillation. The pooled analysis showed a significant association between use of opioids and new-onset atrial fibrillation (hazard ratio 1.96, 95% confidence interval 1.43-2.69 with high heterogeneity). A sensitivity analysis by removing the study with the largest cohort showed similar results to the main analysis. In the summary of findings, the certainty of the evidence according to GRADE was moderate.

conclusionsWe found a significant association between opioid use and the risk of new-onset atrial fibrillation. When prescribing opioids, the risk of new-onset atrial fibrillation should be considered, especially in the presence of other risk factors for atrial fibrillation.

Indexed as

Analgesics, OpioidAtrial FibrillationOpioid-Related DisordersAdultAgedFemaleHumansMaleMiddle AgedRisk FactorsAnalgesics, Opioid

Identifiers

PMID40383741
PMCPMC12423187

What OpenQuestion holds

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Registered trials

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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 OpenQuestion graph.