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. 2022 Aug 9;11(8):620-628.
doi: 10.1093/ehjacc/zuac080.

New-onset atrial fibrillation in intensive care: epidemiology and outcomes

Jonathan P Bedford  1 , Paloma Ferrando-Vivas  2 , Oliver Redfern  1 , Kim Rajappan  3 , David A Harrison  2 , Peter J Watkinson  1   3 , James C Doidge  2
Affiliations

New-onset atrial fibrillation in intensive care: epidemiology and outcomes

Jonathan P Bedford et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

Aims: New-onset atrial fibrillation (NOAF) is common in patients treated on an intensive care unit (ICU), but the long-term impacts on patient outcomes are unclear. We compared national hospital and long-term outcomes of patients who developed NOAF in ICU with those who did not, before and after adjusting for comorbidities and ICU admission factors.

Methods and results: Using the RISK-II database (Case Mix Programme national clinical audit of adult intensive care linked with Hospital Episode Statistics and mortality data), we conducted a retrospective cohort study of 4615 patients with NOAF and 27 690 matched controls admitted to 248 adult ICUs in England, from April 2009 to March 2016. We examined in-hospital mortality; hospital readmission with atrial fibrillation (AF), heart failure, and stroke up to 6 years post discharge; and mortality up to 8 years post discharge. Compared with controls, patients who developed NOAF in the ICU were at a higher risk of in-hospital mortality [unadjusted odds ratio (OR) 3.22, 95% confidence interval (CI) 3.02-3.44], only partially explained by patient demographics, comorbidities, and ICU admission factors (adjusted OR 1.50, 95% CI 1.38-1.63). They were also at a higher risk of subsequent hospitalization with AF [adjusted cause-specific hazard ratio (aCHR) 5.86, 95% CI 5.33-6.44], stroke (aCHR 1.47, 95% CI 1.12-1.93), and heart failure (aCHR 1.28, 95% CI 1.14-1.44) independent of pre-existing comorbidities.

Conclusion: Patients who develop NOAF during an ICU admission are at a higher risk of in-hospital death and readmissions to hospital with AF, heart failure, and stroke than those who do not.

Keywords: Atrial fibrillation; Cohort studies; Critical care; Epidemiology; Intensive care.

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Conflict of interest statement

Conflict of interest: P.J.W. was Chief Medical Officer for Sensyne Health (Oxford, UK); has received grant funding from the National Institute for Health Research (NIHR), the Wellcome Trust and Sensyne Health outside the submitted work; and is supported by the NIHR Biomedical Research Centre, Oxford. J.P.B. is supported by an award to the University of Oxford, NIHR Doctoral Research Fellowship (grant number 300224). O.R. has received grant funding from NIHR and Sensyne Health outside the submitted work.

Figures

Graphical Abstract
Graphical Abstract
Baseline characteristics and outcomes of patients in intensive care with new-onset atrial fibrillation compared with patients without atrial fibrillation.
Figure 1
Figure 1
Record selection and matching.
Figure 2
Figure 2
Cumulative incidence of mortality from intensive care unit admission. Cumulative incidence of mortality estimated using the Kaplan–Meier method.
Figure 3
Figure 3
Cumulative incidence of mortality and hospitalization after hospital discharge. Cumulative incidence of mortality estimated using the Kaplan–Meier method. Cumulative incidences of hospital admission with atrial fibrillation, stroke, and heart failure estimated using non-parametric methods to account for competing risk of death.
See this image and copyright information in PMC

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