New-Onset Atrial Fibrillation (NOAF) in Critically Ill Non-Cardiac ICU Patients: Incidence, Risk Factors, and Outcome Impact

Q: What are the key findings of this study?

New-onset atrial fibrillation occurred in 15.0% of non-cardiac ICU patients and independently increased ICU mortality (42.4% vs 23.4%; adjusted HR 1.63, 95% CI 1.15–2.31, p=0.006).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: New-onset atrial fibrillation in critically ill non-cardiac ICU patients (n=615). Intervention: New-onset atrial fibrillation (NOAF) vs. Maintained sinus rhythm (Non-NOAF). Primary outcome: ICU mortality (HR 1.63, 95% CI 1.15–2.31, p=0.006).

Q: What does this research mean for the field?

New-onset atrial fibrillation occurs in 15% of non-cardiac critically ill patients and is an independent predictor of increased ICU mortality. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Munawar Ali Awan; Muhammad Saleem Awan; Muhammad Arshad; Muhammad Iqbal Qasim; Mansoor Ahmad; Masab Hanif

doi:10.25258/ijddt.16.81s.172

September 29, 2026International Journal of Drug Delivery TechnologyOpen Access

New-Onset Atrial Fibrillation (NOAF) in Critically Ill Non-Cardiac ICU Patients: Incidence, Risk Factors, and Outcome Impact

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Key result

New-onset AF in non-cardiac ICU patients is linked to ~63% higher mortality.

HR 1.63
95% CI 1.15–2.31
P=0.006
n=615

Why the study?

Prospective data on the incidence, risk factors, and clinical outcomes of new-onset atrial fibrillation in critically ill non-cardiac ICU patients were scarce in low- and middle-income settings in South Asia.

Does the development of new-onset atrial fibrillation increase mortality and length of stay compared to maintaining sinus rhythm in critically ill non-cardiac ICU patients?

Key Points

To determine the incidence of new-onset atrial fibrillation (NOAF), identify its independent clinical risk factors, and evaluate its impact on survival among critically ill non-cardiac patients admitted to an intensive care unit.
Prospective observational cohort study conducted from January 2025 to December 2025 at a 9-bed ICU at King Abdullah Teaching Hospital in Mansehra, Pakistan.
Included 615 consecutive adult (age ≥18 years) non-cardiac admissions who arrived in normal sinus rhythm, excluding those with prior atrial fibrillation, cardiac surgery, permanent pacemakers, or ICU stays under 24 hours.
Identified NOAF via continuous or 12-lead ECG (episodes ≥30 seconds) and evaluated independent risk factors and mortality using multivariable logistic regression and Cox proportional hazards models.
NOAF occurred in 92 patients (15.0%, 95% CI 12.2–18.0) at a median of 3 days post-admission; independent risk factors were age ≥65 years (aOR 2.84, 95% CI 1.45–5.56, p=0.002), sepsis or septic shock (aOR 4.21, 95% CI 2.31–7.67, p<0.001), mechanical ventilation (aOR 2.56, 95% CI 1.28–5.11, p=0.008), vasopressor use (aOR 2.13, 95% CI 1.10–4.12, p=0.024), and higher APACHE II score (aOR 1.08 per point, 95% CI 1.03–1.14, p=0.001).
Compared to non-NOAF patients, those developing NOAF had significantly higher ICU mortality (42.4% vs. 23.4%, p<0.001), higher hospital mortality (48.9% vs. 28.7%, p<0.001), longer ICU stays (median 9 vs. 5 days, p<0.001), and higher stroke or thromboembolism rates (4.3% vs. 1.0%, p=0.03).
NOAF remained an independent predictor of ICU mortality after multivariable adjustment (adjusted HR 1.63, 95% CI 1.15–2.31, p=0.006).

Study Design

Type

Cohort (n=615)

Multicenter

No

Structured PICO

Does the development of new-onset atrial fibrillation increase mortality and length of stay compared to maintaining sinus rhythm in critically ill non-cardiac ICU patients?

P

Population

615 consecutive non-cardiac critically ill adults (mean age 58.4 years, 41.8% female) admitted to a Pakistani ICU in sinus rhythm without prior atrial fibrillation or cardiac surgery, followed through hospital discharge.

E

Exposure

Development of new-onset atrial fibrillation or atrial flutter (NOAF) lasting ≥30 seconds on continuous ECG monitoring or 12-lead ECG (n=92)

C

Comparator

Maintenance of sinus rhythm during ICU stay (non-NOAF group, n=523)

O

Outcome

Incidence of new-onset atrial fibrillation (NOAF), defined as atrial fibrillation or atrial flutter lasting ≥30 seconds on continuous ECG monitoring or 12-lead ECG, confirmed by the treating physician, in a patient without prior AFhard clinical

Main Result

Hazard Ratio: 1.63 (95% CI 1.15–2.31)

Absolute Event Rate: 42.4% vs 23.4%

p-value: p=0.006

New-onset atrial fibrillation occurs in 15% of critically ill non-cardiac ICU patients in this South Asian cohort and independently predicts a 63% higher risk of ICU mortality and prolonged hospitalization.

Limitations

Single-center design and 12-month duration may limit generalizability
Intermittent ECG monitoring may have underestimated brief or asymptomatic NOAF episodes
Did not assess anticoagulation practices, long-term mortality, recurrent AF, or long-term stroke outcomes
Observational design prevents establishing causal relationships with possible residual confounding
Sample size was insufficient for detailed subgroup analyses and rare outcomes such as stroke
Single-center design and 12-month duration, which may limit generalizability
Observational design prevents establishing causal relationships, with possible residual confounding from unmeasured factors

Implication

NOAF was associated with higher ICU mortality in non-cardiac patients; extends prior associations but leaves open whether rhythm control improves outcomes.

Abstract

Background:The association of new-onset atrial fibrillation (NOAF) with non-cardiac critically ill patients has been growing and there are few prospective data in low-and middle-income country settings in South Asia.The objective of this study was to measure the rate of NOAF, to identify independent risk factors and to assess clinical outcome in patients who develop NOAF compared to those who stay in sinus rhythm. Methods:It was a prospective observational cohort study carried out from January 2025 to December 2025 at King Abdullah Teaching Hospital, Mansehra in 09 bedded ICU with different case mix.Six hundred and fifteen (615) consecutive adult (age ≥ 18 years) non-cardiac intensive care admissions were included who had arrived in sinus rhythm.Patients who had a history of AF, had undergone cardiac surgery, permanent pacemaker, spent less than 24 hours in the ICU or died were excluded.NOAF was identified as atrial fibrillation/flutter of ≥30 seconds duration as detected by continuous ECG monitoring or 12-lead ECG and confirmed by the treating physician.Independent risk factors were identified using multivariable logistic regression.Survival analysis (Kaplan-Meier) and Cox proportional hazards regression were used to compare mortality between groups. Results:NOAF occurred in 92 patients (15.0%, 95% CI 12.2-18.0).Independent risk factors included age ≥65 years (adjusted OR 2.84, 95% CI 1.45-5.56,p=0.002), sepsis/septic shock (aOR 4.21, 95% CI 2.31-7.67,p<0.001), mechanical ventilation (aOR 2.56, 95% CI 1.28-5.11,p=0.008), vasopressor use (aOR 2.13, 95% CI 1.10-4.12,p=0.024), and higher APACHE II score (aOR 1.08 per point, 95% CI 1.03-1.14,p=0.001).NOAF patients had significantly higher ICU mortality (42.4% vs. 23.4%,p<0.001), hospital mortality (48.9% vs. 28.7%,p<0.001), prolonged ICU stay (median 9 vs. 5 days, p<0.001), and lower spontaneous sinus restoration rate (58.7%).NOAF remained an independent predictor of ICU mortality (adjusted HR 1.63, 95% CI 1.15-2.31,p=0.006). Conclusion:NOAF is found in 15% of the non-cardiac ICU cases at our center and it is highly correlated with the severity of the illness, mechanical support, and sepsis.NOAF is an independent predictor of death and longer hospital stay, indicating that NOAF is a proxy for severity and a factor in adverse outcomes.There is a need to further investigate targeted preventive strategies or early rhythm control in South Asian ICU populations.

Discussion

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Cite This Study

Awan et al. (2026) conducted a cohort in New-onset atrial fibrillation in critically ill non-cardiac ICU patients (n=615). New-onset atrial fibrillation (NOAF) vs. Maintained sinus rhythm (Non-NOAF) was evaluated on ICU mortality (HR 1.63, 95% CI 1.15–2.31, p=0.006). New-onset atrial fibrillation occurred in 15.0% of non-cardiac ICU patients and independently increased ICU mortality (42.4% vs 23.4%; adjusted HR 1.63, 95% CI 1.15–2.31, p=0.006).

synapsesocial.com/papers/6ae28dedcbadf70daf6c3f85 https://doi.org/10.25258/ijddt.16.81s.172

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New-Onset Atrial Fibrillation (NOAF) in Critically Ill Non-Cardiac ICU Patients: Incidence, Risk Factors, and Outcome Impact

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

New-Onset Atrial Fibrillation (NOAF) in Critically Ill Non-Cardiac ICU Patients: Incidence, Risk Factors, and Outcome Impact

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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