Multicenter Study

. 2020 Jan 13;24(1):15.

doi: 10.1186/s13054-020-2730-0.

New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults-a multicenter retrospective cohort study

Shannon M Fernando^{1

2}, Rebecca Mathew^{3

4}, Benjamin Hibbert⁴, Bram Rochwerg^{5

6}, Laveena Munshi^{7

8}, Allan J Walkey^{9

10}, Morten Hylander Møller¹¹, Trevor Simard⁴, Pietro Di Santo⁴, F Daniel Ramirez^{4

12

13}, Peter Tanuseputro^{14

15

16

17}, Kwadwo Kyeremanteng^{3

14

16

18}

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfern014@uottawa.ca.
² Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfern014@uottawa.ca.
³ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴ Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
⁵ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Department of Medicine, Sinai Health System, Toronto, ON, Canada.
⁹ Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
¹⁰ Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA.
¹¹ Department of Intensive Care, Copenhagen University Hospital Righospitalet, Copenhagen, Denmark.
¹² Electrophysiology Service, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.
¹³ L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, Bordeaux-Pessac, France.
¹⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹⁵ Bruyere Research Institute, Ottawa, ON, Canada.
¹⁶ Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁷ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹⁸ Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 31931845
PMCID: PMC6958729
DOI: 10.1186/s13054-020-2730-0

Multicenter Study

New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults-a multicenter retrospective cohort study

Shannon M Fernando et al. Crit Care. 2020.

. 2020 Jan 13;24(1):15.

doi: 10.1186/s13054-020-2730-0.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfern014@uottawa.ca.
² Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfern014@uottawa.ca.
³ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴ Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
⁵ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Department of Medicine, Sinai Health System, Toronto, ON, Canada.
⁹ Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
¹⁰ Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA.
¹¹ Department of Intensive Care, Copenhagen University Hospital Righospitalet, Copenhagen, Denmark.
¹² Electrophysiology Service, Hôpital Cardiologique du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France.
¹³ L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, Bordeaux-Pessac, France.
¹⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹⁵ Bruyere Research Institute, Ottawa, ON, Canada.
¹⁶ Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁷ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹⁸ Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 31931845
PMCID: PMC6958729
DOI: 10.1186/s13054-020-2730-0

Abstract

Background: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs.

Methods: Retrospective analysis (2011-2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost.

Results: We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97-1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09-1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02-1.20]). Among patients with NOAF, treatment with a rhythm-control strategy was associated with higher costs (CR 1.24 [95% CI 1.07-1.40]).

Conclusions: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.

Keywords: Atrial fibrillation; Costs; Critical care; Intensive care unit; Resource utilization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Study flow diagram. AF, atrial fibrillation; ICU, intensive care unit; NOAF, new-onset atrial fibrillation

See this image and copyright information in PMC

Comment in

New-onset atrial fibrillation can be falsely associated with increased length of stay in ICU due to immortal time bias.
Lu Y, Chen T. Lu Y, et al. Crit Care. 2020 Feb 6;24(1):40. doi: 10.1186/s13054-020-2757-2. Crit Care. 2020. PMID: 32028993 Free PMC article. No abstract available.

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New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults-a multicenter retrospective cohort study

Affiliations

New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults-a multicenter retrospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical