Impact of atrial fibrillation on clinical outcomes in 28,492 patients following open-heart cardiac valve surgery: A statewide population-linkage study

Q: What are the key findings of this study?

In patients undergoing aortic valve surgery, new-onset atrial fibrillation was associated with a significantly higher risk of all-cause mortality (HR 1.16) compared to patients without atrial fibrillation.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Open-heart cardiac valve surgery (n=28492). Intervention: New-onset atrial fibrillation (New-AF) vs. No atrial fibrillation (No-AF). Primary outcome: All-cause mortality (Aortic valve surgery subgroup) (HR 1.16, 95% CI 1.10-1.22, p=<0.001).

Q: What does this research mean for the field?

The prognostic impact of atrial fibrillation following open-heart surgery depends on the target valve, with both new-onset and prior atrial fibrillation increasing mortality risk in aortic valve surgery, whereas only prior atrial fibrillation increases mortality risk in mitral valve surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare clinical outcomes associated with prior or new-onset atrial fibrillation between patients undergoing open-heart aortic valve surgery versus mitral valve surgery.

Jia Yi Anna Ne; Cm Chow; Vincent Chow; Karice Hyun; Leonard Kritharides; David Brieger; A. Ng

doi:10.1186/s12916-026-04953-2

May 27, 2026BMC MedicineOpen Access

Impact of atrial fibrillation on clinical outcomes in 28,492 patients following open-heart cardiac valve surgery: A statewide population-linkage study

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Key result

New-onset AF during aortic valve surgery is linked to ~16% higher all-cause mortality.

HR 1.16
95% CI 1.10-1.22
P<0.001
n=28,492

Figures

Why the study?

Atrial fibrillation is common after cardiac surgery, but few studies have compared clinical outcomes associated with AF between patients undergoing aortic valve surgery versus mitral valve surgery.

Does atrial fibrillation status (new or prior) increase the risk of all-cause mortality and non-fatal outcomes in patients undergoing open-heart cardiac valve surgery?

Key Points

To compare clinical outcomes associated with prior or new-onset atrial fibrillation between patients undergoing open-heart aortic valve surgery versus mitral valve surgery.
Statewide population-linkage study of patients undergoing open-heart cardiac valve surgery between 1-July-2003 and 31-March-2021 in Australia (N=28,492; AVSx n=18,949; MVSx n=9,543), followed up to 31-March-2022 with a median duration of 6.58yrs (3.4–10.5yrs).
Patients were categorized by atrial fibrillation status (No-AF vs. New-AF vs. Prior-AF) during index valve surgery admission.
Multivariable Cox regression assessed all-cause mortality and Fine-Gray competing risk analyses evaluated non-fatal cardiovascular outcomes.
During median 6.58yrs follow-up, all-cause mortality was significantly elevated with Prior-AF and New-AF compared to No-AF in both AVSx (57.9% vs. 41.5% vs. 32.8%) and MVSx (41.0% vs. 29.8% vs. 22.4%) (both logrank P<0.001).
In multivariable Cox analysis, both New-AF (aHR=1.16, 95%CI=1.10–1.22) and Prior-AF (aHR=1.69, 95%CI=1.59–1.79) independently predicted all-cause mortality in AVSx, whereas only Prior-AF was associated with mortality in MVSx (aHR=1.47, 95%CI=1.33–1.61), all P<0.001.
Fine-Gray competing risk analysis showed ischaemic stroke rehospitalisation was significantly increased in AVSx New-AF (sHR=1.15, 95%CI=1.01–1.32, P=0.04) and AVSx Prior-AF (sHR=1.34, 95%CI=1.13–1.58, P<0.001), but not in MVSx.

Study Design

Type

Cohort (n=28,492)

Multicenter

Yes

Structured PICO

Does atrial fibrillation status (new or prior) increase the risk of all-cause mortality and non-fatal outcomes in patients undergoing open-heart cardiac valve surgery?

P

Population

28,492 patients who had open-heart cardiac valve surgery (aortic valve surgery [AVSx] or mitral valve surgery [MVSx]), median age 71.6 years, 65.6% males, in Australia.

I

Intervention

Prior atrial fibrillation (Prior-AF) or new-onset atrial fibrillation (New-AF) during index valve surgery

C

Comparator

No atrial fibrillation (No-AF)

O

Outcome

All-cause mortalityhard clinical

Main Result

Effect estimate: HR 1.16 (95% CI 1.10-1.22)

Absolute Event Rate: 41.5% vs 32.8%

p-value: p=<0.001

Implication

Prior and new-onset atrial fibrillation are associated with increased all-cause mortality in patients undergoing aortic valve surgery, whereas only prior AF is associated with increased mortality in mitral valve surgery.

Abstract

Background Atrial fibrillation (AF) is common after cardiac surgery. Few studies compared clinical outcomes associated with AF between patients undergoing aortic valve surgery (AVSx) versus mitral valve surgery (MVSx). Methods Patients who had open-heart cardiac valve surgery (1- July-2003 to 31-March-2021) identified from the Admitted-Patient-Data-Collection database in Australia were stratified by AF status (No-AF vs. New-AF vs. Prior-AF during index valve surgery) and followed up to 31-March-2022. Multivariable Cox regression and Fine-Gray competing risk analyses were performed to assess the association of AF status on all-cause mortality and non-fatal outcomes respectively. Results The cohort comprised 28,492 patients (whole cohort median age 71.6yrs [interquartile range 62.7–78.3yrs]; 65.6% males): AVSx, n = 18,949, median age 73.3 [IR 65.4–79.4yrs], 67.8% males; MVSx, n = 9543, MVSx: median age 67.6 [IR 58.2–75.5yrs], 61.2% males. During a median 6.58yrs (3.4–10.5yrs) follow-up, Prior-AF and New-AF patients had significantly higher all-cause mortality (AVSx-Prior-AF: 57.9% vs. AVSx-New-AF: 41.5% vs. AVSx-No-AF: 32.8%; MVSx-Prior-AF: 41.0% vs. MVSx-New-AF: 29.8% vs. MVSx-No-AF: 22.4%) (both logrank P < 0.001). In the AVSx subgroup, both New-AF and Prior-AF were independently associated with all-cause mortality (aHR = 1.16, 95%CI = 1.10–1.22; aHR = 1.69, 95%CI = 1.59–1.79 respectively) compared to No-AF patients. In the MVSx subgroup, only Prior-AF was associated with increased all-cause mortality (aHR = 1.47, 95% CI = 1.33–1.61), all P < 0.001. Ischaemic stroke was significantly higher in the AVSx New-AF and AVSx-Prior-AF subgroups. Conclusions Patients undergoing valve surgery have different risks of adverse clinical outcomes, with target valve and baseline AF status being associated with these outcomes.

Discussion

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Cite This Study

Ne et al. (2026) conducted a cohort in Open-heart cardiac valve surgery (n=28,492). New-onset atrial fibrillation (New-AF) vs. No atrial fibrillation (No-AF) was evaluated on All-cause mortality (Aortic valve surgery subgroup) (HR 1.16, 95% CI 1.10-1.22, p=<0.001). In patients undergoing aortic valve surgery, new-onset atrial fibrillation was associated with a significantly higher risk of all-cause mortality (HR 1.16) compared to patients without atrial fibrillation.

synapsesocial.com/papers/6a192ea9fab5b468c4417caf https://doi.org/10.1186/s12916-026-04953-2

Topics

Atrial fibrillation

Persistent AF management

Anticoagulation in AF

AF ablation outcomes

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Impact of atrial fibrillation on clinical outcomes in 28,492 patients following open-heart cardiac valve surgery: A statewide population-linkage study

Figures

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

Topics

Impact of atrial fibrillation on clinical outcomes in 28,492 patients following open-heart cardiac valve surgery: A statewide population-linkage study

Figures

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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