Key result
Hyperlipidemia (HR 2.27), immunosuppression (HR 2.29), and increasing age (HR 1.05) were significantly associated with the long-term persistence of new-onset atrial fibrillation after critical illness.
Why the study?
Atrial fibrillation of new onset during acute illness has a variable incidence, and risk factors for its persistence after hospital discharge in critically ill patients needed assessment.
Cohort (n=108)
No
Hazard Ratio: 2.27 (95% CI 1.02–5.05)
p-value: p=0.044
In critically ill patients, new-onset atrial fibrillation has a 38% persistence rate after discharge, driven by age, hyperlipidemia, and immunosuppression, suggesting a need for individualized anticoagulation consideration.
May support risk stratification for post-ICU AF persistence; hypothesis-generating for anticoagulation decisions, requiring prospective trials.
BACKGROUND: Atrial fibrillation (AF) of new onset during acute illness (AFNOAI) has a variable incidence of 1%-44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years after hospital discharge for critically ill patients. METHODS: This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1, 2012, to October 31, 2015, were screened. Those designated with AF for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox's proportional hazards model. RESULTS: Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01-1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02-5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02-5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71-3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91-4.37) also showed a trend towards association with AFNOAI persistence. CONCLUSIONS: Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient's individual AFNOAI persistence risk.
No takes yet. Share an insight, caveat, or question.
Ramanathan et al. (2021) conducted a cohort in Atrial fibrillation of new onset during acute illness (AFNOAI) (n=108). Hyperlipidemia vs. Without hyperlipidemia was evaluated on Persistence of AFNOAI in the 5 years after hospital discharge (HR 2.27, 95% CI 1.02-5.05, p=0.044). Hyperlipidemia (HR 2.27), immunosuppression (HR 2.29), and increasing age (HR 1.05) were significantly associated with the long-term persistence of new-onset atrial fibrillation after critical illness.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: