New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults—a multicenter retrospective cohort study

Abstract

Background: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs. Methods: Retrospective analysis (2011-2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost. Results: We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97-1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09-1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02-1.20]). Among patients with NOAF, treatment with a rhythmcontrol strategy was associated with higher costs (CR 1.24 [95% CI 1.07-1.40]). Conclusions: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.

Evaluation of Anticoagulation Practice With New-Onset Atrial Fibrillation in Patients with Sepsis and Septic Shock in Medical Intensive Care Unit: A Retrospective Observational Cohort Study

“…In a recent analysis of 15,014 patients with critical illness in ICU, 1944 patients had sepsis and 1286 patients had septic shock. NOAF was not associated with increased mortality in critically ill patients in ICU but increased mortality seen among sepsis and septic shock patients with adjusted odds ratio of 1.24 (95% CI 1.1-1.39) and 1.28 (95% CI 1.14-1.44), respectively [ 21 ]. In another large study done in the Netherlands on 1782 patients, 418 patients were found to have 1087 episodes of NOAF and those patients were found to have increased mortality and longer stays in the hospital [ 22 ].…”

New-onset atrial fibrillation can be falsely associated with increased length of stay in ICU due to immortal time bias

“…In a recent study published in Critical Care, Fernando SM and colleagues investigated the impact of new-onset atrial fibrillation (NOAF) on clinical outcomes in critically ill patients [1]. They performed univariate analysis and found that the length of stays (LOS) in ICU and hospital was both longer in the NOAF group versus non-NOAF group.…”

“…The authors would like to thank Drs. Lu and Chen for their comments on our recent article related to outcomes and costs associated with new-onset atrial fibrillation (NOAF) in critically ill adults [1]. Drs.…”

“…New-onset atrial fibrillation can be falsely associated with increased length of stay in ICU due to immortal time bias Yifang Lu 1 and Tenggao Chen 2*…”

Does Serum Uric Acid Status Influence the Association Between Left Atrium Diameter and Atrial Fibrillation in Hypertension Patients?

“…Atrial fibrillation (AF) is the most sustained arrhythmia, contributing to short and long-term cardiovascular complications such as hemodynamic instability, stroke, heart failure, and mortality risk (1)(2)(3)(4)(5). Considering the continuous rise in the average life expectancy in recent years and an increase in cardiac morbidity, the occurrence of AF has been increasing sharply in the past two decades.…”