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. 2021 Sep 27:36:100880.
doi: 10.1016/j.ijcha.2021.100880. eCollection 2021 Oct.

Association of onset time of new-onset atrial fibrillation with in-hospital mortality among critically ill patients: A secondary analysis of a prospective multicenter observational study

Tomoya Okazaki  1 , Takuo Yoshida  2   3 , Shigehiko Uchino  2 , Yusuke Sasabuchi  4 ; AFTER-ICU study group
Affiliations

Association of onset time of new-onset atrial fibrillation with in-hospital mortality among critically ill patients: A secondary analysis of a prospective multicenter observational study

Tomoya Okazaki et al. Int J Cardiol Heart Vasc. .

Abstract

Background: New-onset atrial fibrillation (AF) in critically ill patients is associated with adverse outcomes. In non-critical settings, the circadian variation in paroxysmal AF is of significant interest; however, circadian variation in critically ill patients with new-onset AF has not been thoroughly studied. This study aimed to examine the association between AF onset time and in-hospital mortality.

Methods: This was a secondary analysis of a prospective multicenter observational study enrolling adult critically ill patients. According to AF onset time, patients were divided into nighttime (0:00-7:59), daytime (8:00-15:59), and evening (16:00-23:59). We conducted a multiple logistic regression analysis to assess the potential association between AF onset time and in-hospital mortality. We also assessed the distribution of AF onset, crude in-hospital mortality, and adjusted in-hospital mortality according to bihourly intervals.

Results: Of 423 patients, in-hospital mortality was 26%. During nighttime, 135 patients (32%) developed new-onset AF. AF emerged during daytime for 141 (33%) and during evening for 147 (35%). Daytime AF was significantly associated with an increased risk of in-hospital mortality (adjusted OR: 1.92; 95% CI: 1.07-3.44; p = 0.030). Bihourly interval analysis showed that adjusted in-hospital mortality was unevenly distributed and bimodal with troughs between 6:00 and 7:59 and between 18:00 and 19:59. A similar trend was seen in the distribution of the number of new-onset AF.

Conclusions: We found that the bihourly adjusted in-hospital mortality was distributed in a bimodal fashion. Further research is needed to determine the causes of the diurnal variation and its impact on patient outcomes.

Keywords: Critical illness; In-hospital mortality; New-onset atrial fibrillation; Onset time.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Circadian distribution of the AF onset and crude in-hospital mortality.
Fig. 2
Fig. 2
Circadian distribution of adjusted in-hospital mortality calculated with considering periodicity. The median is indicated by the black lines, and the 25th and 75th percentiles by the hinges, maximum value or 1.5 times of the interquartile range as the bars, and values beyond as points. The overlaid curve shows the predicted curve from the multivariate logistic regression model that took periodicity into account.
See this image and copyright information in PMC

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