Clinical course after identification of new-onset atrial fibrillation in critically ill patients: The AFTER-ICU study

Yoshida, Takuo; Uchino, Shigehiko; Sasabuchi, Yusuke

doi:10.1016/j.jcrc.2020.06.014

Cited by 7 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further, cardioversions done for arrhythmias causing hemodynamic instability may not be effectively preceded by cardiac imaging to rule out intracardiac thrombus. Anticoagulation rates in the ICU remain low; with the AFTER-ICU study noting 60% patients received no anticoagulation in the ICU for atrial fibrillation [26]. All the ischemic strokes in our study occurred in patients admitted to ICU who had recent surgery or hemodynamic compromise and were not preceded by a TEE.…”

Section: Multi-organ Dysfunctionmentioning

confidence: 78%

Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center

et al. 2022

View full text Add to dashboard Cite

Background: Increasing reports suggest the safe use of direct oral anticoagulants (DOACs) in electrical cardioversion. The aim of this study was to assess the trends and 30-day outcomes associated with anticoagulation for cardioversion. Methods:Patients who underwent electrical cardioversion from January 2015 to October 2020 with a 30-day follow-up were included; and outcomes including stroke, transient ischemic attack, intracranial hemorrhage (ICH), and major gastrointestinal bleeding were recorded.Results: Of the 515 patients, 351 (68%) were men and 164 (32%) were women, with a mean CHA 2 DS 2 VASc score of 2.6 ± 1.6. Outpatient apixaban use increased from 10% in 2015 to 46% in 2020 (P < 0.001) with a decline in the use of warfarin from 24% in 2015 to 10% in 2020 (P = 0.023). Apixaban use peri-procedurally for cardioversion increased from 32% in 2015 to 35% in 2020 (P = 0.317), while warfarin use decreased from 23% in 2015 to 14% in 2020 (P = 0.164). At discharge, apixaban prescriptions increased from 21% in 2015 to 61% in 2020 (P < 0.001), while warfarin prescriptions declined from 30% in 2015 to 13% in 2020 (P = 0.009). No ICH was recorded in the 30 days after cardioversion. Ischemic stroke occurred in four (0.7%) patients with one (0.29%) of the 338 patients on a DOAC, one (0.8%) of the 124 patients on warfarin and two (5.5%) of the 36 patients not receiving anticoagulation post cardioversion. There were seven (1%) major gastrointestinal bleeding events in patients on oral anticoagulation, of which four (3%) were on warfarin and three (0.8%) were on DOACs. Conclusions:Our study shows the increasing and safe use of DOACs for the purpose of cardioversion. The rates of 30-day ischemic stroke post cardioversion were low and only occurred in patients admitted in the intensive care unit.

show abstract

Section: Multi-organ Dysfunctionmentioning

confidence: 78%

Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Patients with new-onset AF were seen with a high rate of post-ICU death as compared to those who were not diagnosed with AF. Yoshida et al found new-onset AF patients to have a mortality of 26%, and the rate of stroke with patients still admitted in the hospital was 4.5% [ 13 ]. The authors also concluded that even though the percentage of patients presenting with AF decreased over time with different treatments, the risk of mortality was still very high.…”

Section: Discussionmentioning

confidence: 99%

In-Hospital Mortality Among Critically Ill Patients With Atrial Fibrillation (AF) Versus Patients Without AF

Mehreen¹,

Ishtiaq²,

Rasheed³

et al. 2021

Cureus

View full text Add to dashboard Cite

IntroductionAtrial fibrillation (AF) is one of the most frequent arrhythmias observed in the intensive care unit (ICU). The present study assessed AF as an independent risk factor for mortality among patients in the ICU setting. MethodologyA prospective cohort study was conducted at the medical ICU in a tertiary academic medical center from September 2020 to January 2021. All critically ill patients, irrespective of gender, who were admitted for at least two days in the ICU were eligible to partake in the study. Individuals in the cardiovascular surgical ICU and the trauma ICU were not eligible. Demographics, clinical history, the occurrence of AF, fluid input and output, echocardiography, drug history, and hospital mortality were recorded during the first week of admission. Patients were divided into two groups. ResultsPatients with AF had significantly higher in-hospital mortality, 27 (73%), and longer hospital stays (11.61 ± 7.01) as compared to patients who did not suffer from AF (p<0.0001). The mean length of stay in ICU was 10.32 ± 5.92 and the duration of mechanical ventilation was 7.05 ± 6.16 days in the AF group which was significantly higher than patients who did not have AF (p<0.0001). No significant difference was found in mortality rate between new-onset and recurrent AF among the patients; albeit the latter was higher (60% vs 81.8%, p=0.142). ConclusionThe present study indicated that AF was a predictor of mortality hence, associated with poor patient prognosis. The occurrence of AF was associated with high in-hospital mortality and longer hospital stay. Further large-scale studies should be conducted to explore other socio-demographic and clinical risk factors.

show abstract

“…This study is a post hoc analysis of the AFTER-ICU study, a prospective observational study that included 423 patients with new-onset AF in 32 Japan intensive care units (ICUs) [10,27]. Patients admitted to the ICU between April 1, 2017, and March 31, 2018, were enrolled.…”

Section: Study Design and Settingmentioning

confidence: 99%

“…A previous multicenter study described the epidemiology after identi cation of new-onset AF [27], and another study also reported that sustained new-onset AF was time-dependently associated with hospital mortality [10]. In this study, we aimed to perform a sub-analysis of the AFTER-ICU study in order to assess the impact of rhythm-control therapy on SR restoration in critically ill patients with new-onset AF.…”

mentioning

confidence: 99%

Impact of Rhythm-control Therapy for New-onset Atrial Fibrillation in Critically ill Patients : A Post Hoc Analysis From the Prospective Observational AFTER-ICU study

Yoshida¹,

Uchino

Sasabuchi

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundSustained new-onset atrial fibrillation (AF) is time-dependently associated with hospital mortality. However, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration in critically ill patients is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration in critically ill patients with new-onset AF.MethodsThis study is a post hoc analysis of the AFTER-ICU study, a prospective observational study of patients with new-onset AF in 32 Japan intensive care units. This study included patients with and without rhythm-control therapy with new-onset AF. A multivariable analysis was performed using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration.ResultsOf 423 patients with new-onset AF, 178 (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 hours after AF onset. Magnesium sulfate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16–1.85). The rhythm-control group had higher hospital mortality than the non-rhythm-control group (31% vs. 23%, P=0.09).ConclusionsRhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF.Trial registrationUMIN-CTR UMIN000026401

show abstract

Clinical course after identification of new-onset atrial fibrillation in critically ill patients: The AFTER-ICU study

Cited by 7 publications

References 30 publications

Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center

Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center

In-Hospital Mortality Among Critically Ill Patients With Atrial Fibrillation (AF) Versus Patients Without AF

Impact of Rhythm-control Therapy for New-onset Atrial Fibrillation in Critically ill Patients : A Post Hoc Analysis From the Prospective Observational AFTER-ICU study

Contact Info

Product

Resources

About