CardiovascularThe impact of sustained new-onset atrial fibrillation on mortality and stroke incidence in critically ill patients: A retrospective cohort study
Introduction
Atrial fibrillation (AF) is the most common arrhythmia in critically ill patients [1], [2], [3], with a reported incidence ranging between 4.5 and 15% among patients in the general intensive care unit (ICU) [1], [4], [5], [6], [7], [8], [9], [10], [11]. Multiple previous studies have shown that the development of new-onset AF in critically ill patients is associated with increased mortality [4], [6], [12], [13], [14]. Several studies have also reported the association between the development of new-onset AF in critically ill patients and thromboembolic events [13], [15], [16], [17].
Despite the amount of information available for the development of new-onset AF in critically ill patients, data on the impact of duration of sustained new-onset AF on patient outcomes are scarce [18], [19], [20]. Therefore, it is unclear whether the sustained new-onset AF contributes to poor outcomes or is only a marker of severe disease [21], [22], [23], [24]. With respect to cardiac surgery, results of a clinical trial showed that the administration of antiarrhythmic drugs did not affect patient outcomes once patients develop new-onset AF in the early postoperative period [25], [26]. In non-cardiac surgery patients, however, there are insufficient data on even epidemiology of patient outcomes of sustained new-onset AF [20], [27], [28].
Therefore, we conducted a retrospective cohort study to evaluate the impact of sustained new-onset AF on mortality and stroke incidence in critically ill non-cardiac surgery patients.
Section snippets
Study design and patients
This was a retrospective cohort study in a 20-bed ICU at Jikei University Hospital in Tokyo, Japan. The study protocol was approved by the Jikei University Institutional Review Board (27-062[7947]). Written informed consent was waived in view of the observational nature of this study.
We enrolled non-cardiac surgery patients aged 18 years or older, who were admitted to the ICU between January 1, 2010, and December 31, 2013, and who remained longer than 24 h in the ICU. New-onset AF was defined as
Results
A total of 1718 adult non-cardiac surgery patients were admitted to the ICU and remained there for over 24 h during the study period. We screened these patients using electronic medical records for any record related to AF, and found 297 patients with possible new-onset AF. Of these, 151 patients developed new-onset AF during their ICU stay (Fig. 1).
Patient demographics and clinical characteristics are shown in Table 1. Among the 151 patients, 52 patients (34%) remained in AF (AF group) and 99
Key findings
We conducted a retrospective cohort study to assess the association between sustained new-onset AF and outcomes in critically ill non-cardiac surgery patients. Although there was no statistically significant difference in patient characteristics between the AF and SR groups, patients with AF at 6 h had approximately twice as high in-hospital mortality as patients with SR at 6 h. Multivariable logistic regression analysis confirmed the association between AF at 6 h and in-hospital mortality. In
Conclusion
We analyzed the association between sustained new-onset AF and outcomes in critically ill non-cardiac surgery patients. We found that more than one third of new-onset AF patients remained in AF at 6 h after onset, which was associated with increased in-hospital mortality. We also found that longer AF duration was associated with higher in-hospital mortality and incidence of in-hospital stroke. Further research is warranted to investigate outcomes of critically ill non-cardiac surgery patients
Authors' contributions
T. Yoshida extracted the data, analyzed the data, and wrote the first draft of the manuscript. S. Uchino designed the study, supervised the analysis of the data, and critically revised the manuscript. T. Yokota extracted the data with T. Yoshida and interpreted the data and critically revised the manuscript. TF was in charge of statistical analysis and critically revised the manuscript. S. Uezono interpreted the data and critically revised the manuscript. MT interpreted the data and critically
Ethics approval and consent to participate
The hospital ethics committee of Jikei University School of Medicine approved the study protocol, and the need for informed consent was waived because of the retrospective design of the study.
Competing interests
The authors declare that they have no competing interests.
Funding
The authors declare that they have no sources of funding for the research.
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Clinical course after identification of new-onset atrial fibrillation in critically ill patients: The AFTER-ICU study
2020, Journal of Critical CareCitation Excerpt :New-onset atrial fibrillation (AF) in critically ill patients is the most frequent arrhythmia in intensive care units (ICUs) [1,2]. Most previous studies of new-onset AF in the ICU compared between patients with and without new-onset AF [3–5] and reported that critically ill patients who developed new-onset AF may be at higher risk of a long duration of hospital stay, stroke, and death [1,6–16]. Although several observational studies on patients who developed new-onset AF have been published, there is no high-quality clinical trial that has evaluated the strategy for managing new-onset AF [17–19].