Incidence, treatment and mortality of new-onset atrial fibrillation patients at the intensive care unit

Abstract

ObjectiveCritically ill patients admitted to the intensive care unit (ICU) often develop atrial fibrillation (AF), with an incidence of around 5%. Stroke prevention in AF is well described in clinical guidelines. The extent to which stroke prevention is prescribed to ICU patients with AF is unknown. We aimed to determine the incidence of new-onset AF and describe stroke prevention strategies initiated on the ICU of our teaching hospital. Also, we compared mortality in patients with new-onset AF to critically ill patients with previously diagnosed AF and patients without any AF.MethodsThis study was a retrospective cohort study including all admissions to the ICU of the Martini Hospital (Groningen, The Netherlands) in the period 2011 to 2016. Survival analyses were performed using these real-world data.ResultsIn total, 3334 patients were admitted to the ICU, of whom 213 patients (6.4%) developed new-onset AF. 583 patients (17.5%) had a previous AF diagnosis, the other patients were in sinus rhythm. In-hospital mortality and 1-year mortality after hospital discharge were significantly higher for new-onset AF patients compared with patients with no history of AF or previously diagnosed AF. At hospital discharge, only 56.3% of the new-onset AF-patients eligible for stroke prevention received an anticoagulant. Anticoagulation was not dependent on CHA2DS2-VASc score or other patient characteristics. An effect of anticoagulative status on mortality was not significant.ConclusionAF is associated with increased mortality in critically ill patients admitted to the ICU. More guidance is needed to optimise anticoagulant treatment in critically ill new-onset AF patients.

Automatic Identification of Patients With Unexplained Left Ventricular Hypertrophy in Electronic Health Record Data to Improve Targeted Treatment and Family Screening

“…Our results are in line with other studies using the same approach, for instance reducing the number of patients that needed to be screened for trial inclusion by 80% and a yield of 2-5% for inclusion (25). Other applications for such algorithms include retrospective cohort building, further emphasizing the supportive role of text-mining applications rather than a comprehensive solution replacing human assessment of patient inclusions (25,39,40). Further differentiation among ULVH types may be achieved using disease specific markers in text-mining.…”

Association of Dexmedetomidine With New-Onset Atrial Fibrillation in Patients With Critical Illness

“… 5 NOAF may cause adverse hemodynamic outcomes, systemic embolism, or stroke, resulting in worse clinical outcomes with longer ICU length of stay (LOS) and higher mortality compared with patients without NOAF. 3 , 8 , 9 , 10 …”

“…Commonly proposed risk factors associated with NOAF in patients admitted to the ICU include mechanical ventilation, vasoactive drugs, systemic inflammation, and organ dysfunction . NOAF may cause adverse hemodynamic outcomes, systemic embolism, or stroke, resulting in worse clinical outcomes with longer ICU length of stay (LOS) and higher mortality compared with patients without NOAF …”

“…5 NOAF may cause adverse hemodynamic outcomes, systemic embolism, or stroke, resulting in worse clinical outcomes with longer ICU length of stay (LOS) and higher mortality compared with patients without NOAF. 3,[8][9][10] Dexmedetomidine is a highly selective α2 receptor agonist widely used for sedation in patients with critical illness. It provides sedation by targeting receptors within the locus coeruleus and exerts an analgesic effect via receptors in the spinal cord.…”