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. 2022 Aug 14;43(31):2971-2980.
doi: 10.1093/eurheartj/ehac285.

Post-operative atrial fibrillation and risk of heart failure hospitalization

Parag Goyal  1   2 , Michael Kim  3 , Udhay Krishnan  1 , Stephen A Mccullough  1 , Jim W Cheung  1 , Luke K Kim  1 , Ambarish Pandey  4 , Barry A Borlaug  5 , Evelyn M Horn  1 , Monika M Safford  2 , Hooman Kamel  6
Affiliations

Post-operative atrial fibrillation and risk of heart failure hospitalization

Parag Goyal et al. Eur Heart J. .

Abstract

Aims: Post-operative atrial fibrillation (POAF) is associated with stroke and mortality. It is unknown if POAF is associated with subsequent heart failure (HF) hospitalization. This study aims to examine the association between POAF and incident HF hospitalization among patients undergoing cardiac and non-cardiac surgeries.

Methods and results: A retrospective cohort study was conducted using all-payer administrative claims data that included all non-federal emergency department visits and acute care hospitalizations across 11 states in the USA. The study population included adults aged at least 18 years hospitalized for surgery without a prior diagnosis of HF. Cox proportional hazards regression models were used to examine the association between POAF and incident HF hospitalization after making adjustment for socio-demographics and comorbid conditions. Among 76 536 patients who underwent cardiac surgery, 14 365 (18.8%) developed incident POAF. In an adjusted Cox model, POAF was associated with incident HF hospitalization [hazard ratio (HR) 1.33; 95% confidence interval (CI) 1.25-1.41]. In a sensitivity analysis excluding HF within 1 year of surgery, POAF remained associated with incident HF hospitalization (HR 1.15; 95% CI 1.01-1.31). Among 2 929 854 patients who underwent non-cardiac surgery, 23 763 (0.8%) developed incident POAF. In an adjusted Cox model, POAF was again associated with incident HF hospitalization (HR 2.02; 95% CI 1.94-2.10), including in a sensitivity analysis excluding HF within 1 year of surgery (HR 1.49; 95% CI 1.38-1.61).

Conclusions: Post-operative atrial fibrillation is associated with incident HF hospitalization among patients without prior history of HF undergoing both cardiac and non-cardiac surgeries. These findings reinforce the adverse prognostic impact of POAF and suggest that POAF may be a marker for identifying patients with subclinical HF and those at elevated risk for HF.

Keywords: Atrial fibrillation; Heart failure.

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Conflict of interest statement

Conflict of interest: P.G. receives personal fees for medicolegal consulting related to heart failure and has received honoraria from Akcea Inc. and Bionest Inc. H.K. serves as a PI for the NIH-funded ARCADIA trial (NINDS U01NS095869), which receives in-kind study drug from the BMS-Pfizer Alliance for Eliquis® and ancillary study support from Roche Diagnostics; as Deputy Editor for JAMA Neurology; on clinical trial steering/executive committees for Medtronic, Janssen, and Javelin Medical; and on endpoint adjudication committees for NovoNordisk and Boehringer-Ingelheim. B.A.B. receives research support from the NIH/NHLBI, Axon, AstraZeneca, Corvia, Medtronic, GlaxoSmithKline, Mesoblast, Novartis, Tenax Therapeutics, and consults/serves on advisory boards for Actelion, Amgen, Aria, Boehringer-Ingelheim, Edwards, Eli Lilly, Imbria, Janssen, Merck, Novo Nordisk, VADovations.

Figures

Structured Graphical Abstract
Structured Graphical Abstract
Associations between post-operative atrial fibrillation and incident heart failure hospitalization were observed following cardiac and non-cardiac surgeries. AF, atrial fibrillation.
Figure 1
Figure 1
Flow diagram of patients included in an analysis of post-operative atrial fibrillation and heart failure.
Figure 2
Figure 2
Cumulative rates of heart failure hospitalization after cardiac surgery, stratified by status of atrial fibrillation. Cumulative rates differed significantly among groups (P < 0.001 by log-rank test).
Figure 3
Figure 3
Cumulative rates of heart failure hospitalization after non-cardiac surgery, stratified by status of atrial fibrillation. Cumulative rates differed significantly among groups (P < 0.001 by log-rank test).
See this image and copyright information in PMC

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