Prognostic impact of sustained new-onset atrial fibrillation in critically ill patients

Intensive Care Med. 2020 Jan;46(1):27-35. doi: 10.1007/s00134-019-05822-8. Epub 2019 Nov 4.

Abstract

Purpose: The development of new-onset atrial fibrillation (AF) in critically ill patients may be associated with poor outcomes. However, it is unknown whether sustained new-onset AF contributes to worse outcome. The aim of this study was to assess whether sustained new-onset AF is associated with stroke and death and to look for a possible dose-response relationship between AF duration and death.

Methods: In a prospective cohort study conducted in 32 intensive care units in Japan from 2017 to 2018, we enrolled adult patients with new-onset AF. We compared patients with AF duration longer than 48 h with those with AF duration shorter than 48 h. To assess a dose-response relationship between AF duration and hospital mortality, we conducted landmark analysis and time-dependent Cox regression analysis.

Results: Among a total of 423 new-onset AF patients, hospital mortality was 25%, and the incidence of in-hospital stroke was 4.6%. AF duration longer than 48 h was not independently associated with hospital mortality (adjusted odds ratio: 1.52; 95% Confidence Interval: 0.87-2.64). The incidence of in-hospital stroke was 7.6% in patients with AF duration longer than 48 h and 3.8% in those with AF duration shorter than 48 h (p = 0.154). When analyzing time more continuously, we observed a time-dependent association between AF duration and hospital mortality (p = 0.005 by landmark analysis and p = 0.019 by Cox analysis).

Conclusions: Sustained new-onset AF was time-dependently associated with hospital mortality in ICU patients, albeit with some uncertainty since AF duration longer than 48 h was not independently associated with in-hospital death or stroke.

Keywords: Critical illness; Duration of atrial fibrillation; Mortality; New-onset atrial fibrillation; Stroke.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / physiopathology
  • Chi-Square Distribution
  • Cohort Studies
  • Correlation of Data
  • Critical Illness / epidemiology
  • Critical Illness / mortality*
  • Critical Illness / therapy
  • Female
  • Humans
  • Incidence
  • Japan
  • Male
  • Middle Aged
  • Odds Ratio
  • Prognosis*
  • Prospective Studies
  • Risk Factors
  • Statistics, Nonparametric
  • Time Factors*