July 6, 2022European Heart Journal Acute Cardiovascular Care32 citationsOpen Access

New-onset atrial fibrillation in intensive care: epidemiology and outcomes

JBJonathan Bedford PFPaloma Ferrando-Vivas OROliver Redfern

Structured PICO

Does the development of new-onset atrial fibrillation during an ICU admission increase the risk of in-hospital mortality and long-term cardiovascular readmissions in critically ill adults?

Population

32,305 adult patients (≥16 years) admitted to 248 general ICUs for ≥4 hours in England, comprising 4,615 patients who developed new-onset atrial fibrillation (NOAF) and 27,690 matched controls. Excluded cardiothoracic ICU admissions.

Intervention

Development of new-onset atrial fibrillation (NOAF) during ICU admission

Comparator

Matched controls who did not develop NOAF during or prior to ICU admission

Outcome

In-hospital mortality; hospital readmission with atrial fibrillation, heart failure, and stroke up to 6 years post discharge; and mortality up to 8 years post dischargehard clinical

New-onset atrial fibrillation during an ICU admission is independently associated with increased in-hospital mortality and long-term risks of readmission for AF, stroke, and heart failure, highlighting the need for post-discharge cardiological surveillance.

Limitations

Sensitivity of diagnostic records (NOAF may have been present but not recorded, or ambiguous if new vs pre-existing)
Prioritized specificity over sensitivity leading to low reported incidence
Missing data on risk factors like dyslipidaemia, smoking, alcohol use, and anticoagulation therapy
Did not analyze outcomes of patients with pre-existing AF

Abstract

AIMS: New-onset atrial fibrillation (NOAF) is common in patients treated on an intensive care unit (ICU), but the long-term impacts on patient outcomes are unclear. We compared national hospital and long-term outcomes of patients who developed NOAF in ICU with those who did not, before and after adjusting for comorbidities and ICU admission factors. METHODS AND RESULTS: Using the RISK-II database (Case Mix Programme national clinical audit of adult intensive care linked with Hospital Episode Statistics and mortality data), we conducted a retrospective cohort study of 4615 patients with NOAF and 27 690 matched controls admitted to 248 adult ICUs in England, from April 2009 to March 2016. We examined in-hospital mortality; hospital readmission with atrial fibrillation (AF), heart failure, and stroke up to 6 years post discharge; and mortality up to 8 years post discharge. Compared with controls, patients who developed NOAF in the ICU were at a higher risk of in-hospital mortality unadjusted odds ratio (OR) 3.22, 95% confidence interval (CI) 3.02-3.44, only partially explained by patient demographics, comorbidities, and ICU admission factors (adjusted OR 1.50, 95% CI 1.38-1.63). They were also at a higher risk of subsequent hospitalization with AF adjusted cause-specific hazard ratio (aCHR) 5.86, 95% CI 5.33-6.44, stroke (aCHR 1.47, 95% CI 1.12-1.93), and heart failure (aCHR 1.28, 95% CI 1.14-1.44) independent of pre-existing comorbidities. CONCLUSION: Patients who develop NOAF during an ICU admission are at a higher risk of in-hospital death and readmissions to hospital with AF, heart failure, and stroke than those who do not.

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