A retrospective study on atrial fibrillation after coronary artery bypass grafting surgery at The National Heart Institute, Kuala Lumpur

Abstract

Background: Atrial fibrillation (AF) is common after cardiac surgery and has been associated with poor outcome and increased resource utilization. The main objective of this study is to determine the incidence of POAF in Malaysia and identify the predictors of developing POAF. The secondary outcome of this study would be to investigate the difference in mortality and morbidity rates and the duration of intensive care unit (ICU), high dependency unit (HDU) and hospital stay between the two. Methods: This is a retrospective single-center, cross sectional study conducted at the National Heart Institute, Malaysia. Medical records of 637 who underwent coronary artery bypass grafting (CABG) surgery in 2015 were accrued. Pre-operative, operative and post-operative information were subsequently collected on a pre-formulated data collection sheet. Data were then analyzed using IBM SPSS v23. Results: The incidence of POAF in our study stands at 28.7% with a mean onset of 45±33 hours post operatively. Variables with independent association with POAF include advancing age, Indian population, history of chronic kidney disease, left ventricular ejection fraction and beta-blocker treatment. The mortality rate is significantly higher statistically ( p < 0.05), and similarly the incidence of stroke. The incidence of other post-operative complications was also significantly higher statistically. The duration of ICU, HDU and hospital stays were statistically longer ( p < 0.001) with higher rates of ICU readmissions and reintubations seen. Conclusion: We conclude that the incidence of POAF in Malaysia is comparable to the figures in Western countries, making POAF one of the most commonly encountered condition after CABG with similar higher rates of mortality, poor outcomes and longer duration of stay, and therefore increased cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care.

Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis

“…For sample size calculation, we used the PS Power and Sample Size Calculation Software (Version 3. We estimated sample size based on findings from a prior study by Musa et al [3]. The researchers found POAF incidence at IJN to be 28.7%.…”

“…It occurs in about 20% to 40% [1] of patients after isolated coronary bypass grafting (CABG) and more often after combined CABG and valve surgery [2]. In an earlier retrospective study [3], we observed a prolonged Cardiac Intensive Care Unit (CICU) stay, High Dependency Unit (HDU) stay and total hospital stay among these patients, with a projected increase in resource utilisation. This was accompanied by a statistically significant increase in the incidence of stroke and death [3].…”

Perioperative risk factors for new‐onset postoperative atrial fibrillation among patients after isolated coronary artery bypass grafting: A retrospective study

“…The prevalence of new‐onset POAF varies between 20% and 40% after CABG, especially during the first postoperative week (Dobrev et al, 2019; Gudbjartsson et al, 2020). New‐onset POAF following CABG can lead to prolonged hospitalization, intensive care unit stay and worse long‐term survival as well as increased medical costs (Dobrev et al, 2019; Farouk et al, 2018). Until now, POAF in cardiac care is critical issue, even though the dramatically advances in cardiac surgery and perioperative care (Ghurram et al, 2020; Greenberg et al, 2017).…”

“…As POAF is associated with the increased morbidity and mortality, recent studies have reported that advanced age and pre‐existing comorbidities such as atrial fibrillation, renal failure and heart failure significantly increase the risk of POAF after CABG (Dobrev et al, 2019; Farouk et al, 2018; Greenberg et al, 2017; Gudbjartsson et al, 2020). However, these studies were limited to a certain period, such as preoperative or postoperative, during which they identified the comprehensive risk factors (Higgs et al, 2020; Mangi et al, 2019; Vidotti et al, 2019).…”