Key result
New-onset atrial fibrillation in critically ill patients significantly increased the risk of 1-year mortality by 15.5% compared to patients with no atrial fibrillation (HR 1.155).
Why the study?
Atrial fibrillation is the most prevalent arrhythmia in critically ill patients, motivating an evaluation of the impact of new-onset AF on mortality in this population.
Does new-onset atrial fibrillation increase mortality in adult critically ill patients?
Cohort (n=48,018)
No
Does new-onset atrial fibrillation increase mortality in adult critically ill patients?
Hazard Ratio: 1.155 (95% CI 1.101–1.212)
Absolute Event Rate: 34.04% vs 20.69%
p-value: p=<0.001
In critically ill patients, new-onset atrial fibrillation is independently associated with a significantly higher risk of 1-year mortality compared to both no AF and pre-existing AF.
May warrant closer ICU surveillance as a severity marker; leaves open causality and whether prevention or treatment reduces mortality.
Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in critically ill patients and significantly impacts mortality. This study sought to evaluate the impact of new-onset AF on mortality in a critically ill population. Methods: This study identified 48018 adult patients admitted to the ICU from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients were categorized as no AF, pre-existing AF, or new-onset AF. We analyzed mortality at 3 months, 6 months, and 1 year. Results: Overall, 31,562 (65.73%) patients had no AF, 4877 (10.16%) had pre-existing AF, and 11,579 (24.11%) had new-onset AF. Median ages were 61.47 years (no AF), 76.12 years (pre-existing AF), and 75.26 years (new-onset AF). New-onset AF was associated with the highest mortality rates: 25.16% at 3 months, 29.23% at 6 months, and 34.04% at 1 year, compared to 17.94%, 22.55%, and 28.52% for pre-existing AF, and 14.54%, 17.25%, and 20.69% for no AF respectively (p < 0.001 for all). Multivariate Cox regression indicated that new-onset AF significantly increased the risk of 1-year mortality by 15.5% compared to no AF (HR: 1.155, 95% CI: 1.101-1.212; p < 0.001) and by 23.9% compared to pre-existing AF (HR: 1.239, 95% CI: 1.164-1.318; p < 0.001). Kaplan-Meier analysis confirmed lower survival probabilities for new-onset AF over one year compared to the other groups (p < 0.001). Conclusion: In patients with critical illness, new-onset AF is associated with an increased risk of mortality compared with pre-existing AF or no AF.
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Zhang et al. (2024) conducted a cohort in Critical illness (n=48,018). New-onset atrial fibrillation vs. No atrial fibrillation was evaluated on 1-year mortality (HR 1.155, 95% CI 1.101-1.212, p=<0.001). New-onset atrial fibrillation in critically ill patients significantly increased the risk of 1-year mortality by 15.5% compared to patients with no atrial fibrillation (HR 1.155).
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