Postoperative atrial fibrillation after cardiac surgery was associated with a 1-year rate of stroke or vascular death of 2.3% versus 1.5% without POAF (aHR 1.32; 95% CI 0.99-1.77).
Cohort (n=12,234)
Yes
Does new-onset postoperative atrial fibrillation increase the risk of stroke, vascular death, or all-cause death in adults undergoing cardiac surgery?
New-onset postoperative atrial fibrillation occurs in nearly a third of cardiac surgery patients and is associated with significantly increased risks of subsequent clinical atrial fibrillation and all-cause mortality at 1 year.
Effect estimate: aHR 1.32 (95% CI 0.99-1.77)
Absolute Event Rate: 2.3% vs 1.5%
Abstract Background and Aims New-onset atrial fibrillation (AF) is the most common complication of cardiac surgery. We aimed to describe the incidence of postoperative AF (POAF), its management, and its relationship to long-term outcomes in a prospective multi-centre cohort, as our current understanding comes primarily from registries and single-centre studies. Methods VISION Cardiac Surgery was a prospective cohort of adults who underwent cardiac surgery in 12 countries. The association of POAF with outcomes occurring between 30 days and 1 year postoperatively was estimated using a multivariable Cox model adjusted for patient and operative characteristics and for antithrombotic therapies. Results Among 12 234 patients (55.3% isolated coronary artery bypass grafting), 31.8% had POAF within 30 days of surgery. The proportion of participants with POAF who received anticoagulation alone at hospital discharge was 15.6%, 54.3% received antiplatelets alone, 23.9% received anticoagulation and antiplatelets, and 6.3% received neither; 48.8% were receiving amiodarone. At 1 year, clinical AF was detected in 6.9% of patients with POAF compared to 0.6% in those without adjusted hazard ratio (aHR), 11.30; 95% confidence interval (CI) 8.17–15.70. The primary composite outcome of stroke or vascular death occurred in 2.3% of patients with POAF and 1.5% in those without POAF (aHR 1.32; 95% CI 0.99–1.77). Patients with POAF had a higher risk of all-cause death (3.0% vs 1.7%; aHR 1.54; 95% CI 1.18–2.00). Conclusions New-onset POAF occurs in a third of patients after cardiac surgery; its antithrombotic and antiarrhythmic management varies. Patients with POAF have increased risks of both clinical AF and of all-cause death in the year following surgery.
“One of the goals of these guidelines was not to promote a single dominant therapy, but to provide a structured, phase-based approach that can reduce unwarranted practice variation while still allowing clinical judgment.”
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McIntyre et al. (Wed,) conducted a cohort in Postoperative atrial fibrillation (n=12,234). Postoperative atrial fibrillation vs. No postoperative atrial fibrillation was evaluated on Composite outcome of stroke or vascular death (aHR 1.32, 95% CI 0.99-1.77). Postoperative atrial fibrillation after cardiac surgery was associated with a 1-year rate of stroke or vascular death of 2.3% versus 1.5% without POAF (aHR 1.32; 95% CI 0.99-1.77).