Authors' objectives: To determine whether there is any evidence on the (causal) association of being a firefighter, active or retired, and the development of atrial fibrillation or atrial flutter.

Authors' results and conclusions: Seven published studies were identified from our search on the Ovid platform and an additional study was identified from NIOSHTIC-2 search. Upon examination on the titles and abstracts of these eight studies, six were thought to be relevant and were retrieved in full for further appraisal. The primary studies included in a systematic review, investigating the non-cancer health risk in firefighters by Kim et al, were manually traced but will not be discussed further. With regard to atrial fibrillation, a primary study by Pedersen et al was also identified in this search. Pedersen et al constructed a large (n=11691) retrospective cohort of firefighters, and employed reference groups based on data from the Supplementary Pension Fund Register including a random sample of men from the general employed population (n=396906) as well as all past and current employees from the Danish military (n=262548) as the second reference group, in their attempt to estimate the risks of specific diagnoses of cardiovascular diseases (CVD) by firefighting employment type (fulltime vs part-time/volunteer). Results for the total cohort of firefighters showed a significant small increased risk for all CVDs combined and significantly increased risks were observed for the three most frequent CVD outcomes (angina pectoris, acute myocardial infarction and chronic ischaemic heart disease) in comparison with the general employed population sample. Although this study employed a large sample size, there was no specific hypothesis was postulated and tested. In the absence of such hypothesis, this study reported numerous statistical tests without necessarily adjusting for the type I error level (multiple comparisons). Further, the nature of the data employed did not provide data/opportunity to adjust for other potential confounders, such as smoking, physical activities, etc., that may affect the reported outcomes. A self-reported survey-based study by Vanchiere et al investigates the association between AF and occupational exposure in FF. Data for this study was collected, in an electronic cross-sectional survey and in one of multivariate logistic regression the authors performed, results showed that a higher number of fires fought per year was associated with an increased risk of atrial fibrillation, however, it should strongly be noted that potential selection bias, associated with self-selected participation as well as excluded participants, cannot be excluded from affecting the results. LaSee et al utilized claim data from Washington State where a study of 2000- 2017 associated with heart problems, however, it is not clear how many of these claims with accepted heart problems were for atrial fibrillation. At present, there is no data to support the (causal) association in the development of atrial fibrillation/atrial flutter among retired firefighters. At present, there may be some data to support the association between being an active firefighter and the development of atrial fibrillation/atrial flutter. However, this finding has to be interpreted with caution as chance and confounding cannot be ruled out in affecting the observed outcome.

Authors' methods: A comprehensive and systematic literature search was conducted on January 24, 2024. The search was done on commercial and non-commercial medical literature databases. A combination of keywords was employed on this search. No limitation, such as on the language or date of publication, was implemented in these searches. A manual search was also done on the references of the articles that were retrieved in full.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2024

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/causal-association-between-firefighting-atrial-fibrillation-atrial-flutter?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DDate%26q%3DCausal%2520Association%2520Between%2520Firefighting%2520and%2520Atrial%2520Fibrillation%2520and%2520or%2520Atrial%2520Flutter%26f%3Alanguage-facet%3D%5BEnglish%5D%26tags%3DGuide%7C2d7eb4b30f6a4a319e0d40565c9abbab%2CHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=Causal%20Association%20Between%20Firefighting%20and%20Atrial%20Fibrillation%20and%20or%20Atrial%20Flutter

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

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