Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients
- PDF / 822,457 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 70 Downloads / 173 Views
ORIGINAL
Prognostic impact of sustained new‑onset atrial fibrillation in critically ill patients Takuo Yoshida1* , Shigehiko Uchino1, Yusuke Sasabuchi2, Yasuhiro Hagiwara3 and the AFTER-ICU study group © 2019 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Purpose: The development of new-onset atrial fibrillation (AF) in critically ill patients may be associated with poor outcomes. However, it is unknown whether sustained new-onset AF contributes to worse outcome. The aim of this study was to assess whether sustained new-onset AF is associated with stroke and death and to look for a possible dose–response relationship between AF duration and death. Methods: In a prospective cohort study conducted in 32 intensive care units in Japan from 2017 to 2018, we enrolled adult patients with new-onset AF. We compared patients with AF duration longer than 48 h with those with AF duration shorter than 48 h. To assess a dose–response relationship between AF duration and hospital mortality, we conducted landmark analysis and time-dependent Cox regression analysis. Results: Among a total of 423 new-onset AF patients, hospital mortality was 25%, and the incidence of in-hospital stroke was 4.6%. AF duration longer than 48 h was not independently associated with hospital mortality (adjusted odds ratio: 1.52; 95% Confidence Interval: 0.87–2.64). The incidence of in-hospital stroke was 7.6% in patients with AF duration longer than 48 h and 3.8% in those with AF duration shorter than 48 h (p = 0.154). When analyzing time more continuously, we observed a time-dependent association between AF duration and hospital mortality (p = 0.005 by landmark analysis and p = 0.019 by Cox analysis). Conclusions: Sustained new-onset AF was time-dependently associated with hospital mortality in ICU patients, albeit with some uncertainty since AF duration longer than 48 h was not independently associated with in-hospital death or stroke. Keywords: New-onset atrial fibrillation, Duration of atrial fibrillation, Critical illness, Mortality, Stroke
*Correspondence: [email protected] 1 Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Nishi‑Shinbashi Minato‑ku, Tokyo 105‑8471, Japan Full author information is available at the end of the article
The members of the AFTER-ICU study group have been given in the Acknowledgements section.
Introduction Atrial fibrillation (AF) is the most common arrhythmia in critically ill patients [1–3]. AF may exacerbate hemodynamic instability and increase the risk of developing thrombosis [4–7]. Previous studies have reported that new-onset AF in critically ill patients is associated with longer hospital stays and a higher risk of stroke and mortality [8–13]. However, the clinical course and management of patients after the development of new-onset AF in the intensive care unit (ICU) have not been well studied [7, 14, 15]. Treatment goals for AF generally include reducing the frequency and severity of symptoms, in order to prevent tachycardia-related card
Data Loading...
