Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow‐up cohort study

Abstract

Atrial fibrillation occurring transiently with stress (AFOTS) describes the first detection of AF in a patient who is hospitalized for a non-cardiac medical illness or following non-cardiac surgery. Uncertainty exists whether episodes of AFOTS are due to reversible precipitants and will not recur after recovery, or if they are paroxysmal atrial fibrillation (AF) that is detected during inpatient cardiac monitoring. Previous studies have used retrospective, non-systematic and ultimately low-sensitivity protocols to investigate the recurrence of AF in patients with AFOTS. The prospective, multi-center, investigator-initiated AFOTS Follow-Up Cohort Study will enroll 138 case patients with AFOTS in the setting of non-cardiac surgery or medical illness, matched 1:1 with control patients for age, sex, stressor, and hospital unit. Participants will wear a 14-day ECG heart monitor at 1 and 6 months after hospital discharge. Over 12 months of follow-up, we will collect data regarding participant's medications, and clinical events. The primary endpoint is detection of 30 or more seconds of AF after hospital discharge. To date, 50% of the target sample has been enrolled. The study is expected to complete enrolment in mid-2019 and conclude 1 year later. The AFOTS follow-up study will employ a systematic protocol to detect AF and will provide a precise and valid estimate of AF recurrence following AFOTS. This study will establish whether patients with AFOTS have an increased propensity to AF after hospitalization as compared to matched controls and may inform the management of this population.

High-Sensitivity Estimate of the Incidence of New-Onset Atrial Fibrillation in Critically Ill Patients

“…Similarly, this study was not designed to assess the association of AF with inhospital outcomes. Finally, the study was also not designed to assess long-term outcomes, although some participants were coenrolled into our ongoing AFOTS follow-up study ( 26 ).…”

Association Between Perioperative Atrial Fibrillation and Long-term Risks of Stroke and Death in Noncardiac Surgery: Systematic Review and Meta-analysis

“…Recent studies have shown that a large proportion of patients with postoperative AF may have recurrent AF episodes detected in the months and years after their index hospitalization, 14,[22][23][24] and an ongoing prospective study is addressing rates of AF recurrence. 25 If perioperative AF is the first episode or first presentation of paroxysmal AF, then these patients may have an increased long-term risk of stroke and death. No systematic evaluation of the data of the long-term risks of stroke and death in patients with new-onset perioperative AF after noncardiac surgery is available.…”

Self-monitoring for recurrence of secondary atrial fibrillation following non-cardiac surgery or acute illness: A pilot study

“…Our detection rate of 34% over 30 days of self-monitoring, is similar to the detection rate of 30% noted in a recent study that used an event recorder for ~14-days during months 1-, 6-, and 12 following discharge after surgery for malignancy [17] . To date, we are not aware of any other prospective studies that have reported on secondary AF recurrence after discharge, although a Canadian study is in progress [18] . Our previous study that employed similar methodology to the current study using a handheld ECG following cardiac surgery, identified an AF recurrence rate of 24% within 17-days of discharge [14] .…”