Clinical new-onset atrial fibrillation in critically ill patients was associated with increased hospital mortality (OR 1.63) and a longer intensive care unit length of stay.
Cohort (n=8,356)
No
Does new-onset atrial fibrillation increase hospital mortality and length of stay in critically ill adult ICU patients?
New-onset atrial fibrillation is common in critically ill patients and is independently associated with increased hospital mortality and longer ICU length of stay, though not with post-discharge survival.
Odds Ratio: 1.63 (95% CI 1.01–2.63)
OBJECTIVE: To determine the association of new-onset atrial fibrillation with outcomes, including ICU length of stay and survival. DESIGN: Retrospective cohort of ICU admissions. We found atrial fibrillation using automated detection (≥ 90 s in 30 min) and classed as new-onset if there was no prior diagnosis of atrial fibrillation. We identified determinants of new-onset atrial fibrillation and, using propensity matching, characterized its impact on outcomes. SETTING: Tertiary care academic center. PATIENTS: A total of 8,356 consecutive adult admissions to either the medical or surgical/trauma/burn ICU with available continuous electrocardiogram data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: From 74 patient-years of every 15-minute observations, we detected atrial fibrillation in 1,610 admissions (19%), with median burden less than 2%. Most atrial fibrillation was paroxysmal; less than 2% of admissions were always in atrial fibrillation. New-onset atrial fibrillation was subclinical or went undocumented in 626, or 8% of all ICU admissions. Advanced age, acute respiratory failure, and sepsis were the strongest predictors of new-onset atrial fibrillation. In propensity-adjusted regression analyses, clinical new-onset atrial fibrillation was associated with increased hospital mortality (odds ratio, 1.63; 95% CI, 1.01-2.63) and longer length of stay (2.25 d; CI, 0.58-3.92). New-onset atrial fibrillation was not associated with survival after hospital discharge (hazard ratio, 0.99; 95% CI, 0.76-1.28 and hazard ratio, 1.11; 95% CI, 0.67-1.83, respectively, for subclinical and clinical new-onset atrial fibrillation). CONCLUSIONS: Automated analysis of continuous electrocardiogram heart rate dynamics detects new-onset atrial fibrillation in many ICU patients. Though often transient and frequently unrecognized, new-onset atrial fibrillation is associated with poor hospital outcomes.
Moss et al. (2017) conducted a cohort in Critical illness (n=8,356). Clinical new-onset atrial fibrillation vs. No atrial fibrillation was evaluated on Hospital mortality (OR 1.63, 95% CI 1.01-2.63). Clinical new-onset atrial fibrillation in critically ill patients was associated with increased hospital mortality (OR 1.63) and a longer intensive care unit length of stay.