Risk factors for new-onset atrial fibrillation on the general adult ICU: A systematic review

Abstract

Purpose: This study was performed to systematically review the available evidence for the risk factors for new-onset atrial fibrillation (NOAF) on the general adult intensive care unit (ICU) and provide a semi-quantitative evidence synthesis.

Methods: We searched the MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and the CENTRAL databases from 1970 to 2018. We included studies of adults based in general ICUs that evaluated potential risk factors for NOAF. We excluded studies involving patients with a history of atrial fibrillation (AF). We semi-qualitatively evaluated the strength of evidence for each identified variable.

Results: We screened 1447 studies. Seventeen studies were included in the final analysis. We identified strong evidence for age, male sex, preceding cardiovascular disease, acute renal failure, acute respiratory failure, APACHE score and the use of vasopressors as risk factors for the development of NOAF on the ICU. Modifiable risk factors had not been studied in detail.

Conclusions: We provide the first systematic review with evidence synthesis of risk factors for NOAF on the general adult ICU. Evidence for modifiable risk factors was limited. Further research is therefore required and may contribute towards the evidence-based prevention and management of this important condition.

Keywords: Atrial fibrillation; Critical illness; Intensive care units; Risk factors.