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Johnston KJ, Signer R, Huckins LM. Chronic Overlapping Pain Conditions and Nociplastic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.06.27.23291959. [PMID: 38766033 PMCID: PMC11100847 DOI: 10.1101/2023.06.27.23291959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Chronic Overlapping Pain Conditions (COPCs) are a subset of chronic pain conditions commonly comorbid with one another and more prevalent in women and assigned female at birth (AFAB) individuals. Pain experience in these conditions may better fit with a new mechanistic pain descriptor, nociplastic pain, and nociplastic type pain may represent a shared underlying factor among COPCs. We applied GenomicSEM common-factor genome wide association study (GWAS) and multivariate transcriptome-wide association (TWAS) analyses to existing GWAS output for six COPCs in order to find genetic variation associated with nociplastic type pain, followed by genetic correlation (linkage-disequilibrium score regression), gene-set and tissue enrichment analyses. We found 24 independent single nucleotide polymorphisms (SNPs), and 127 unique genes significantly associated with nociplastic type pain, and showed nociplastic type pain to be a polygenic trait with significant SNP-heritability. We found significant genetic overlap between multisite chronic pain and nociplastic type pain, and to a smaller extent with rheumatoid arthritis and a neuropathic pain phenotype. Tissue enrichment analyses highlighted cardiac and thyroid tissue, and gene set enrichment analyses emphasized potential shared mechanisms in cognitive, personality, and metabolic traits and nociplastic type pain along with distinct pathology in migraine and headache. We use a well-powered network approach to investigate nociplastic type pain using existing COPC GWAS output, and show nociplastic type pain to be a complex, heritable trait, in addition to contributing to understanding of potential mechanisms in development of nociplastic pain.
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Affiliation(s)
- Keira J.A. Johnston
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Rebecca Signer
- Department of Genetic and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Laura M. Huckins
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
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Sadat B, Al Taii H, Sabayon M, Narayanan CA. Atrial Fibrillation Complicating Acute Myocardial Infarction: Prevalence, Impact, and Management Considerations. Curr Cardiol Rep 2024; 26:313-323. [PMID: 38483761 DOI: 10.1007/s11886-024-02040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF) and myocardial infarction (MI) often coexist, and this overlapping nature leads to heightened morbidity and increases the need for comprehensive risk management strategies. The precise trajectory and implications of atrial fibrillation complicating myocardial infarction remain subjects of debate, with divergent reports presenting varying accounts. This review seeks to provide an in-depth exploration of the existing literature to cover the predictors, implication, and available management of new onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI). RECENT FINDINGS Clinical risk factors, laboratory markers, echocardiographic findings, and angiographic data can be used to assess patients at risk of developing NOAF post-AMI. The diagnosis of NOAF post MI has been associated with overall worse short- and long-term prognosis with increased risk for mortality, cardiogenic shock, stroke, and bleeding, along with reduced rates of coronary angiography and percutaneous coronary intervention, and higher risk of future recurrence of AF and ischemic stroke. Despite the paucity of preventative treatment, the optimal management of acute coronary syndrome and the use of guideline directed therapy do decrease the risk of development of atrial fibrillation post myocardial infarction.
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Affiliation(s)
- Besher Sadat
- Division of Cardiovascular Medicine, Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Haider Al Taii
- Division of Cardiovascular Medicine, Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Muhie Sabayon
- Division of Cardiovascular Medicine, Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Chockalingam A Narayanan
- Division of Cardiovascular Medicine, Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
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Wang W, Dong Y, Zhang Q, Gao H. Atrial fibrillation is not an independent determinant of 28-day mortality among critically III sepsis patients. BMC Anesthesiol 2023; 23:336. [PMID: 37803320 PMCID: PMC10557240 DOI: 10.1186/s12871-023-02281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023] Open
Abstract
This study was conducted to investigate the relationship between atrial fibrillation and the clinical prognosis of patients with sepsis in intensive care unit. A total of 21,538 sepsis patients were enrolled in the study based on the Medical Information Mart for Intensive Care IV database, of whom 6,759 had AF. Propensity score matching was used to compare the clinical characteristics and outcomes of patients with and without AF. Besides, the inverse probability of treatment weighting, univariate and multivariate Cox regression analyzes were performed. Of the 21,538 patients, 31.4% had AF. The prevalence of AF increased in a step-by-step manner with growing age. Patients with AF were older than those without AF. After PSM, 11,180 patients remained, comprising 5,790 matched pairs in both groups. In IPTW, AF was not associated with 28-day mortality [hazard ratio (HR), 1.07; 95% confidence interval (CI), 0.99-1.15]. In Kaplan-Meier analysis, it was not observed difference of 28-day mortality between patients with and without AF. AF could be associated with increased ICU LOS, hospital LOS and need for mechanical ventilation; however, it does not remain an independent short-term predictor of 28-day mortality among patients with sepsis after PSM with IPTW and multivariate analysis.
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Affiliation(s)
- Weiping Wang
- Department of Cardiology, Sunshine Union Hospital, Weifang, 261072, Shandong , China
| | - Yujiang Dong
- Department of Cardiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250001, Shandong, China
| | - Qian Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
| | - Hongmei Gao
- Department of Cardiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250001, Shandong, China.
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McIntyre WF, Vadakken ME, Connolly SJ, Mendoza PA, Lengyel AP, Rai AS, Latendresse NR, Grinvalds AJ, Ramasundarahettige C, Acosta JG, Um KJ, Roberts JD, Conen D, Wong JA, Devereaux PJ, Belley-Côté EP, Whitlock RP, Healey JS. Atrial Fibrillation Recurrence in Patients With Transient New-Onset Atrial Fibrillation Detected During Hospitalization for Noncardiac Surgery or Medical Illness : A Matched Cohort Study. Ann Intern Med 2023; 176:1299-1307. [PMID: 37782930 DOI: 10.7326/m23-1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is often detected for the first time in patients who are hospitalized for another reason. Long-term risks for AF recurrence in these patients are unclear. OBJECTIVE To estimate risk for AF recurrence in patients with new-onset AF during a hospitalization for noncardiac surgery or medical illness compared with a matched population without AF. DESIGN Matched cohort study. (ClinicalTrials.gov: NCT03221777). SETTING Three academic hospitals in Hamilton, Ontario, Canada. PARTICIPANTS The study enrolled patients hospitalized for noncardiac surgery or medical illness who had transient new-onset AF. For each participant, an age- and sex-matched control participant with no history of AF from the same hospital ward was recruited. All participants left the hospital in sinus rhythm. MEASUREMENTS 14-day electrocardiographic (ECG) monitor at 1 and 6 months and telephone assessment at 1, 6, and 12 months. The primary outcome was AF lasting at least 30 seconds on the monitor or captured by ECG 12-lead during routine care at 12 months. RESULTS Among 139 participants with transient new-onset AF (70 patients with medical illness and 69 surgical patients) and 139 matched control participants, the mean age was 71 years (SD, 10), the mean CHA2DS2-VASc score was 3.0 (SD, 1.5), and 59% were male. The median duration of AF during the index hospitalization was 15.8 hours (IQR, 6.4 to 49.6 hours). After 1 year, recurrent AF was detected in 33.1% (95% CI, 25.3% to 40.9%) of participants in the transient new-onset AF group and 5.0% (CI, 1.4% to 8.7%) of matched control participants; after adjustment for the number of ECG monitors worn and for baseline clinical differences, the adjusted relative risk was 6.6 (CI, 3.2 to 13.7). After exclusion of participants who had electrical or pharmacologic cardioversion during the index hospitalization (n = 40) and their matched control participants and limiting to AF events detected by the patch ECG monitor, recurrent AF was detected in 32.3% (CI, 23.1% to 41.5%) of participants with transient new-onset AF and 3.0% (CI, 0% to 6.4%) of matched control participants. LIMITATIONS Generalizability is limited, and the study was underpowered to evaluate subgroups and clinical predictors. CONCLUSION Among patients who have transient new-onset AF during a hospitalization for noncardiac surgery or medical illness, approximately 1 in 3 will have recurrent AF within 1 year. PRIMARY FUNDING SOURCE Peer-reviewed grants.
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Affiliation(s)
- William F McIntyre
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Maria E Vadakken
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | - Stuart J Connolly
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Pablo A Mendoza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (P.A.M.)
| | - Alexandra P Lengyel
- Population Health Research Institute, and Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (A.P.L.)
| | - Anand S Rai
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | - Nicole R Latendresse
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | - Alex J Grinvalds
- Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
| | | | - J Gabriel Acosta
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (J.G.A.)
| | - Kevin J Um
- Division of Cardiology, Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (K.J.U., J.D.R.)
| | - Jason D Roberts
- Division of Cardiology, Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (K.J.U., J.D.R.)
| | - David Conen
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Jorge A Wong
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - P J Devereaux
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
| | - Emilie P Belley-Côté
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; Population Health Research Institute; and Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (E.P.B.)
| | - Richard P Whitlock
- Department of Health Research Methods, Evidence, and Impact, McMaster University; Population Health Research Institute; Michael G. DeGroote School of Medicine, McMaster University; Division of Critical Care, Department of Medicine, McMaster University; and Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada (R.P.W.)
| | - Jeff S Healey
- Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
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Andreasen AS, Wetterslev M, Sigurdsson MI, Bove J, Kjaergaard J, Aslam TN, Järvelä K, Poulsen M, De Geer L, Agarwal A, Kjaer MBN, Møller MH. New-onset atrial fibrillation in critically ill adult patients-an SSAI clinical practice guideline. Acta Anaesthesiol Scand 2023; 67:1110-1117. [PMID: 37289426 DOI: 10.1111/aas.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Acute or new-onset atrial fibrillation (NOAF) is the most common cardiac arrhythmia in critically ill adult patients, and observational data suggests that NOAF is associated to adverse outcomes. METHODS We prepared this guideline according to the Grading of Recommendations Assessment, Development and Evaluation methodology. We posed the following clinical questions: (1) what is the better first-line pharmacological agent for the treatment of NOAF in critically ill adult patients?, (2) should we use direct current (DC) cardioversion in critically ill adult patients with NOAF and hemodynamic instability caused by atrial fibrillation?, (3) should we use anticoagulant therapy in critically ill adult patients with NOAF?, and (4) should critically ill adult patients with NOAF receive follow-up after discharge from hospital? We assessed patient-important outcomes, including mortality, thromboembolic events, and adverse events. Patients and relatives were part of the guideline panel. RESULTS The quantity and quality of evidence on the management of NOAF in critically ill adults was very limited, and we did not identify any relevant direct or indirect evidence from randomized clinical trials for the prespecified PICO questions. We were able to propose one weak recommendation against routine use of therapeutic dose anticoagulant therapy, and one best practice statement for routine follow-up by a cardiologist after hospital discharge. We were not able to propose any recommendations on the better first-line pharmacological agent or whether to use DC cardioversion in critically ill patients with hemodynamic instability induced by NOAF. An electronic version of this guideline in layered and interactive format is available in MAGIC: https://app.magicapp.org/#/guideline/7197. CONCLUSIONS The body of evidence on the management of NOAF in critically ill adults is very limited and not informed by direct evidence from randomized clinical trials. Practice variation appears considerable.
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Affiliation(s)
- Anne Sofie Andreasen
- Department of Intensive Care, Copenhagen University Hospital - Herlev, Herlev, Denmark
| | - Mik Wetterslev
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Ingi Sigurdsson
- Division of Anesthesia and Intensive Care Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jeppe Bove
- Department of Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tayyba Naz Aslam
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kati Järvelä
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Mette Poulsen
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Lina De Geer
- Department of Anaesthesiology and Intensive Care, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Norway
| | | | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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6
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Wetterslev M, Hylander Møller M, Granholm A, Hassager C, Haase N, Lange T, Myatra SN, Hästbacka J, Arabi YM, Shen J, Cronhjort M, Lindqvist E, Aneman A, Young PJ, Szczeklik W, Siegemund M, Koster T, Aslam TN, Bestle MH, Girkov MS, Kalvit K, Mohanty R, Mascarenhas J, Pattnaik M, Vergis S, Haranath SP, Shah M, Joshi Z, Wilkman E, Reinikainen M, Lehto P, Jalkanen V, Pulkkinen A, An Y, Wang G, Huang L, Huang B, Liu W, Gao H, Dou L, Li S, Yang W, Tegnell E, Knight A, Czuczwar M, Czarnik T, Perner A. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study. Crit Care Med 2023; 51:1124-1137. [PMID: 37078722 DOI: 10.1097/ccm.0000000000005883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN Multicenter, prospective, inception cohort study. SETTING Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99). CONCLUSIONS In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Sheila N Myatra
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yaseen M Arabi
- Department of Intensive Care Medicine, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jiawei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Maria Cronhjort
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anders Aneman
- Department of Intensive Care Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Clinical School, University of New South Wales, Warwick Farm, NSW, Australia
| | - Paul J Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Martin Siegemund
- Intensive Care Medicine, Department of Acute Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thijs Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tayyba Naz Aslam
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mia S Girkov
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Mohanty
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Joanne Mascarenhas
- Department of Medicine and Critical Care, Breach Candy Hospital Trust, Mumbai, India
| | - Manoranjan Pattnaik
- Department of Pulmonary Medicine, SCB Medical College & Hospital, Cuttack, India
| | - Sara Vergis
- Department of Anaesthesia and Critical Care, MOSC Medical College, Kolenchery, India
| | | | - Mehul Shah
- Department of Critical Care Medicine, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Ziyokov Joshi
- Department of Cardiac Anaesthesiology and Critical Care, Tagore Hospital, Jalandhar, India
| | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pasi Lehto
- Department of Anaesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Anni Pulkkinen
- Department of Anesthesia and Intensive Care, Central Finland Central Hospital, Central Finland Health Care District, Jyväskylä, Finland
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Guoxing Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Huang
- Department of Intensive Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Bin Huang
- Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wei Liu
- Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hengbo Gao
- Department of Critical Care Medicine, The Second Hospital, Hebei Medical University, Hebei, China
| | - Lin Dou
- Department of Intensive Care Medicine, Tianjin First Center Hospital, Tianjin, China
| | - Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Wanchun Yang
- Emergency Intensive Care Unit, Xinjiang Production and Construction Crops 13 div Red Star Hospital
| | - Emily Tegnell
- Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agnes Knight
- Department of Anaesthesia and Intensive Care, Hudiksvall Hospital, Hudiksvall, Sweden
| | - Miroslaw Czuczwar
- Second Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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7
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Chyou JY, Barkoudah E, Dukes JW, Goldstein LB, Joglar JA, Lee AM, Lubitz SA, Marill KA, Sneed KB, Streur MM, Wong GC, Gopinathannair R. Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e676-e698. [PMID: 36912134 DOI: 10.1161/cir.0000000000001133] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient's underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient's ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.
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8
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Nielsen FE, Stæhr CS, Sørensen RH, Schmidt TA, Abdullah SMOB. National Early Warning Score and New-Onset Atrial Fibrillation for Predicting In-Hospital Mortality or Transfer to the Intensive Care Unit in Emergency Department Patients with Suspected Bacterial Infections. Infect Drug Resist 2022; 15:3967-3979. [PMID: 35924025 PMCID: PMC9339666 DOI: 10.2147/idr.s358544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose There are conflicting data regarding the role of the National Early Warning Score 2 (NEWS2) in predicting adverse outcomes in patients with infectious diseases. New-onset atrial fibrillation (NO-AF) has been suggested as a sepsis-defining sign of organ dysfunction. This study aimed to examine the prognostic accuracy of NEWS2 and whether NO-AF can provide prognostic information in emergency department (ED) patients with suspected bacterial infections. Patients and Methods Secondary analyses of data from a prospective observational cohort study of adults admitted in a 6-month period with suspected bacterial infections. We used the composite endpoint of in-hospital mortality or transfer to the intensive care unit as the primary outcome. The prognostic accuracy of NEWS2 and quick sequential organ failure assessment (qSOFA) and covariate-adjusted area under the receiver operating curves (AAUROC) were used to describe the performance of the scores. Logistic regression analysis was used to examine the association between NO-AF and the composite endpoint. Results A total of 2055 patients were included in this study. The composite endpoint was achieved in 198 (9.6%) patients. NO-AF was observed in 80 (3.9%) patients. The sensitivity and specificity for NEWS2 ≥5 were 70.2% (63.3–76.5) and 60.2% (57.9–62.4), respectively, and those for qSOFA ≥2 were 26.3% (20.3–33.0) and 91.0% (89.6–92.3), respectively. AAUROC for NEWS2 and qSOFA were 0.68 (0.65–0.73) and 0.63 (0.59–0.68), respectively. The adjusted odds ratio for achieving the composite endpoint in 48 patients with NO-AF who fulfilled the NEWS2 ≥5 criteria was 2.71 (1.35–5.44). Conclusion NEWS2 had higher sensitivity but lower specificity and better, albeit poor, discriminative ability to predict the composite endpoint compared to qSOFA. NO-AF can provide important prognostic information.
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Affiliation(s)
- Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Correspondence: Finn Erland Nielsen, Department of Emergency Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark, Tel +45 26822753, Fax +45 38639863, Email
| | - Christina Seefeldt Stæhr
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Thomas Andersen Schmidt
- Department of Emergency Medicine, Nordsjaellands Hospital, Hilleroed, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S M Osama Bin Abdullah
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
- Department of Internal Medicine, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
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9
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Wetterslev M, Karlsen APH, Granholm A, Haase N, Hassager C, Møller MH, Perner A. Treatments of new-onset atrial fibrillation in critically ill patients: a systematic review with meta-analysis. Acta Anaesthesiol Scand 2022; 66:432-446. [PMID: 35118653 DOI: 10.1111/aas.14032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) is common in hospitalised patients with critical illness and associated with worse outcomes. Several interventions are available in the management of NOAF, but the overall effectiveness and safety of these interventions compared with placebo or no treatment are unknown. METHODS We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials (RCT) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses, the Cochrane Collaboration, and Grading of Recommendations Assessment, Development and Evaluation statements. We searched RCTs assessing any pharmacological and non-pharmacological treatment compared with placebo or no treatment in critically ill hospitalised patients with NOAF. The primary outcomes were all-cause mortality, adverse events, and health-related quality of life. RESULTS We included 16 trials (n = 1891) evaluating seven interventions. All trials were adjudicated 'some concerns' or 'high risk' of bias. The evidence is very uncertain for mortality (RR 0.53, 95% CI 0.03-8.30), adverse events (RR 1.28, 95% CI 0.85-1.92), and treatment efficacy i.e. rhythm control (RR 1.54, 95% CI 1.20-1.97; TSA-adjusted CI 0.56-4.53) between pharmacological treatment and placebo/no treatment (very low certainty evidence). There were no data for health-related quality of life or most of our secondary outcomes. CONCLUSIONS The existing data are insufficient to firmly conclude on effects of any intervention against NOAF on any outcome in hospitalised patients with critical illness. Randomised trials of the most frequently used interventions against NOAF are warranted in these patients.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Peder Højer Karlsen
- Department of Anaesthesia Centre for Anaesthesiological Research Zealand University Hospital Roskilde Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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10
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Wetterslev M, Møller MH, Granholm A, Hassager C, Haase N, Aslam TN, Shen J, Young PJ, Aneman A, Hästbacka J, Siegemund M, Cronhjort M, Lindqvist E, Myatra SN, Kalvit K, Arabi YM, Szczeklik W, Sigurdsson MI, Balik M, Keus F, Perner A, Huang B, Yan M, Liu W, Deng Y, Zhang L, Suk P, Mørk Sørensen K, Andreasen AS, Bestle MH, Krag M, Poulsen LM, Hildebrandt T, Møller K, Møller‐Sørensen H, Bove J, Kilsgaard TA, Salam IA, Brøchner AC, Strøm T, Sølling C, Kolstrup L, Boczan M, Rasmussen BS, Darfelt IS, Jalkanen V, Lehto P, Reinikainen M, Kárason S, Sigvaldason K, Olafsson O, Vergis S, Mascarenhas J, Shah M, Haranath SP, Van Der Poll A, Gjerde S, Fossum OK, Strand K, Wangberg HL, Berta E, Balsliemke S, Robertson AC, Pedersen R, Dokka V, Brügger‐Synnes P, Czarnik T, Albshabshe AA, Almekhlafi G, Knight A, Tegnell E, Sjövall F, Jakob S, Filipovic M, Kleger G, Eck RJ. Management of acute atrial fibrillation in the intensive care unit: An international survey. Acta Anaesthesiol Scand 2022; 66:375-385. [PMID: 34870855 DOI: 10.1111/aas.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. METHOD We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. RESULTS A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. CONCLUSION This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tayyba Naz Aslam
- Department of Anaesthesiology Division of Emergencies and Critical Care Rikshospitalet Oslo University Hospital Oslo Norway
| | - Jiawei Shen
- Department of Critical Care Medicine Peking University People's Hospital Beijing China
| | - Paul J. Young
- Intensive Care Specialist and co‐Director, Intensive Care Unit Wellington Hospital Wellington New Zealand
- Intensive Care Programme Director Medical Research Institute of New Zealand Wellington New Zealand
- Australian and New Zealand Intensive Care Research Centre Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anders Aneman
- Department of Intensive Care Medicine Liverpool Hospital South Western Sydney Local Health District and South Western Sydney Clinical School University of New South Wales Sydney Australia
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Martin Siegemund
- Department of Intensive Care Medicine Department of Clinical Research University Hospital Basel and University of Basel Basel Switzerland
| | - Maria Cronhjort
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Sheila N. Myatra
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Yaseen M. Arabi
- Department of Intensive Care Medicine Ministry of National Guard Health Affairs King Saud bin Abdulaziz University for Health Sciences King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
| | - Martin I. Sigurdsson
- Division of Anaesthesia and Intensive Care Perioperative Services at Landspitali The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Martin Balik
- Department of Anesthesiology and Intensive Care 1st Faculty of Medicine General University Hospital Charles University Prague Czech Republic
| | - Frederik Keus
- Department of Critical Care University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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11
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Shah KB, Saado J, Kerwin M, Mazimba S, Kwon Y, Mangrum JM, Salerno M, Haines DE, Mehta NK. Meta-Analysis of New-Onset Atrial Fibrillation Versus No History of Atrial Fibrillation in Patients With Noncardiac Critical Care Illness. Am J Cardiol 2022; 164:57-63. [PMID: 34815061 DOI: 10.1016/j.amjcard.2021.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
The incidence of new-onset secondary atrial fibrillation (NOSAF) is as high as 44% in noncardiac critical illness. A systematic review and meta-analysis were performed to evaluate the impact of NOSAF, compared with history of prior atrial fibrillation (AF) and no history of AF in noncardiac critically ill patients. Patients undergoing cardiothoracic surgery were excluded. NOSAF incidence, intensive care unit (ICU)/hospital length of stay (LOS), and mortality outcomes were analyzed. Of 2,360 studies reviewed, 19 studies met inclusion criteria (n = 306,805 patients). NOSAF compared with no history of AF was associated with increased in-hospital mortality (risk ratio [RR] 2.06, 95% confidence interval [CI] 1.76 to 2.41, p <0.001), longer ICU LOS (standardized difference in means [SMD] 0.66, 95% CI 0.41 to 0.91, p <0.001), longer hospital LOS (SMD 0.31, 95% CI 0.07 to 0.56, p = 0.001) and increased risk of long-term (>1 year) mortality (RR 1.76, 95% CI 1.29 to 2.40, p <0.001). NOSAF compared with previous AF was also associated with higher in-hospital mortality (RR 1.29, 95% CI 1.12 to 1.49, p <0.001), longer ICU LOS (SMD 0.37, 95% CI 0.03 to 0.70, p = 0.03) but no difference in-hospital LOS (SMD -0.18, 95% CI -0.66 to 0.31, p = 0.47). In conclusion, NOSAF, in the setting of noncardiac critical illness is associated with increased in-hospital mortality compared with no history of AF and previous AF. NOSAF (vs no history of AF) is also associated with increased long-term mortality.
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Affiliation(s)
- Kuldeep B Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
| | - Jonathan Saado
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.
| | - Matthew Kerwin
- Department of Internal Medicine, University of Virginia, Charlottesville, Virginia.
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
| | - Younghoon Kwon
- Division of Cardiovascular Medicine and Critical care medicine, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington.
| | - James Michael Mangrum
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
| | - Michael Salerno
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
| | - David E Haines
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
| | - Nishaki K Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
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12
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Afzal B, Ali SA, Jamil B. Outcome of Atrial Fibrillation in Patients With Sepsis. Cureus 2021; 13:e19159. [PMID: 34873502 PMCID: PMC8631484 DOI: 10.7759/cureus.19159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 01/09/2023] Open
Abstract
Background Atrial fibrillation (AF) is one of the most frequent arrhythmias in critically ill patients. Sepsis is a major cause of inpatient mortality and it has been associated with cardiac arrhythmias. The objective of this study was to study the outcome of atrial fibrillation in patients who are admitted with sepsis. Methods This is a prospective, single-center cohort study of patients admitted to the Medicine Department between June 1, 2019, and November 30, 2019. The inclusion criteria were adult patients with sepsis and septic shock. In this study, 113 patients were enrolled and outcomes were compared between the group that developed atrial fibrillation during the hospital stay and the group without atrial fibrillation. Results There were 57 (50.4%) patients with AF including 23 (20.4%) who also had a prior history. Total inpatient mortality was 42 (37.2%), of which 17 patients (40.5%) had AF. AF was not found to be associated with higher mortality or increased length of hospital stay (p-value 0.103 and 0.858, respectively). Conclusion AF was not found to be a cause of higher mortality in patients with sepsis or septic shock. There is a need for larger-scale studies to find out the causes of high inpatient mortality in sepsis and the need for local guidelines regarding the management of AF in critically ill patients.
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Affiliation(s)
- Benish Afzal
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Syed Ahsan Ali
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Bushra Jamil
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, PAK
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13
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Ramanathan A, Pearl JP, Li M, Wang X, Sadana D, Duggal A. Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for persistence after hospital discharge. Acute Crit Care 2021; 36:317-321. [PMID: 34784660 PMCID: PMC8907468 DOI: 10.4266/acc.2021.00577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Atrial fibrillation (AF) of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years after hospital discharge for critically ill patients. Methods This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1, 2012, to October 31, 2015, were screened. Those designated with AF for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model. Results Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence. Conclusions Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.
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Affiliation(s)
| | - John Paul Pearl
- Department of Critical Care, Cleveland Clinic, Cleveland, OH, USA
| | - Manshi Li
- Quantitative Health Sciences, Lerner Research institute, Cleveland, OH, USA
| | - Xiaofeng Wang
- Quantitative Health Sciences, Lerner Research institute, Cleveland, OH, USA
| | - Divyajot Sadana
- Department of Critical Care, Cleveland Clinic, Cleveland, OH, USA
| | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, OH, USA
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14
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Fabritz L, Crijns HJGM, Guasch E, Goette A, Häusler KG, Kotecha D, Lewalter T, Meyer C, Potpara TS, Rienstra M, Schnabel RB, Willems S, Breithardt G, Camm AJ, Chan A, Chua W, de Melis M, Dimopoulou C, Dobrev D, Easter C, Eckardt L, Haase D, Hatem S, Healey JS, Heijman J, Hohnloser SH, Huebner T, Ilyas BS, Isaacs A, Kutschka I, Leclercq C, Lip GYH, Marinelli EA, Merino JL, Mont L, Nabauer M, Oldgren J, Pürerfellner H, Ravens U, Savelieva I, Sinner MF, Sitch A, Smolnik R, Steffel J, Stein K, Stoll M, Svennberg E, Thomas D, Van Gelder IC, Vardar B, Wakili R, Wieloch M, Zeemering S, Ziegler PD, Heidbuchel H, Hindricks G, Schotten U, Kirchhof P. Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference. Europace 2021; 23:329-344. [PMID: 33555020 DOI: 10.1093/europace/euaa279] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/28/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS The risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes. METHODS AND RESULTS This article summarizes the outcomes of the 7th Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence. CONCLUSION The remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.
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Affiliation(s)
- Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, UK.,Department of Cardiology, University Hospital Birmingham, UK
| | - Harry J G M Crijns
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands
| | - Eduard Guasch
- Hospital Clinic, IDIBAPS, CIBERCV, University of Barcelona, Spain
| | - Andreas Goette
- Medical Clinic II, St. Vincenz Krankenhaus, Paderborn, Germany.,Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | | | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Thorsten Lewalter
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Internistisches Klinikum München Süd, Germany
| | - Christian Meyer
- University Heart Center, University Hospital Hamburg-Eppendorf, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Clinical Centre of Serbia, Serbia
| | | | - Renate B Schnabel
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,University Heart Center, University Hospital Hamburg-Eppendorf, Germany
| | - Stephan Willems
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Guenter Breithardt
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiovascular Medicine, University Hospital Münster, Germany
| | - A John Camm
- St George's Hospital Medical School, University of London, UK
| | | | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | | | | | - Dobromir Dobrev
- Department of Cardiology, University Hospital Essen, Germany
| | - Christina Easter
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Lars Eckardt
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiovascular Medicine, University Hospital Münster, Germany
| | - Doreen Haase
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - Stephane Hatem
- Department of Cardiology, Sorbonne Universités, Faculté de médecine UPMC, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeff S Healey
- Population Health Research Institute Hamilton, Canada
| | - Jordi Heijman
- Department of Cardiology, University Hospital Birmingham, UK
| | | | | | | | - Aaron Isaacs
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands
| | - Ingo Kutschka
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Klinik für Thorax-, Herz- und Gefäßchirurgie, University Hospital Göttingen, Germany
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, UK
| | | | - Jose L Merino
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, Spain
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Michael Nabauer
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Medizinische Klinik und Poliklinik I, University Hospital Munich, Germany
| | - Jonas Oldgren
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Helmut Pürerfellner
- Department für Rhythmologie und Elektrophysiologie, Ordensklinikum Linz, Austria
| | - Ursula Ravens
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Institut für Experimentelle Kardiovaskuläre Medizin, Universitätsherzzentrum Freiburg, Bad Krozingen, Germany
| | | | - Moritz F Sinner
- Medizinische Klinik und Poliklinik I, University Hospital Munich, Germany
| | - Alice Sitch
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | | | | | | | - Monika Stoll
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands
| | - Emma Svennberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd's Hospital Stockholm, Sweden
| | - Dierk Thomas
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Internal Medicine III-Cardiology, Angiology and Pneumonology, Medical University Hospital Heidelberg, Germany
| | - Isabelle C Van Gelder
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - Reza Wakili
- Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, University Hospital Essen, Germany
| | | | - Stef Zeemering
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - Hein Heidbuchel
- Department of Cardiology, Antwerp University, University Hospital, Belgium
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany
| | - Ulrich Schotten
- School for Cardiovascular Diseases, Maastricht University Medical Centre, the Netherlands.,Atrial Fibrillation NETwork (AFNET), Münster, Germany.,Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, UK.,Atrial Fibrillation NETwork (AFNET), Münster, Germany.,University Heart Center, University Hospital Hamburg-Eppendorf, Germany
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15
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Wetterslev M, Jacobsen PK, Hassager C, Jøns C, Risum N, Pehrson S, Bastiansen A, Andreasen AS, Tjelle Kristiansen K, Bestle MH, Mohr T, Møller‐Sørensen H, Perner A. Cardiac arrhythmias in critically ill patients with coronavirus disease 2019: A retrospective population-based cohort study. Acta Anaesthesiol Scand 2021; 65:770-777. [PMID: 33638870 PMCID: PMC8014528 DOI: 10.1111/aas.13806] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/14/2021] [Accepted: 02/14/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) may be associated with cardiac arrhythmias in hospitalized patients, but data from the ICU setting are limited. We aimed to describe the epidemiology of cardiac arrhythmias in ICU patients with COVID-19. METHODS We conducted a multicenter, retrospective cohort study including all ICU patients with an airway sample positive for severe acute respiratory syndrome corona-virus 2 from March 1st to June 1st in the Capital Region of Denmark (1.8 million inhabitants). We registered cardiac arrhythmias in ICU, potential risk factors, interventions used in ICU and outcomes. RESULTS From the seven ICUs we included 155 patients with COVID-19. The incidence of cardiac arrhythmias in the ICU was 57/155 (37%, 95% confidence interval 30-45), and 39/57 (68%) of these patients had this as new-onset arrhythmia. Previous history of tachyarrhythmias and higher disease severity at ICU admission were associated with cardiac arrhythmias in the adjusted analysis. Fifty-four of the 57 (95%) patients had supraventricular origin of the arrhythmia, 39/57 (68%) received at least one intervention against arrhythmia (eg amiodarone, IV fluid or magnesium) and 38/57 (67%) had recurrent episodes of arrhythmia in ICU. Patients with arrhythmias in ICU had higher 60-day mortality (63%) as compared to those without arrhythmias (39%). CONCLUSION New-onset supraventricular arrhythmias were frequent in ICU patients with COVID-19 and were related to previous history of tachyarrhythmias and severity of the acute disease. The mortality was high in these patients despite the frequent use of interventions against arrhythmias.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Christian Jøns
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Niels Risum
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Steen Pehrson
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Anders Bastiansen
- Department of Anaesthesia and Intensive Care Bispebjerg Hospital and Frederiksberg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care Herlev HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Klaus Tjelle Kristiansen
- Department of Anaesthesia and Intensive Care Hvidovre HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Morten H. Bestle
- Department of Anaesthesia and Intensive Care Nordsjællands HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Thomas Mohr
- Department of Anaesthesia and Intensive Care Gentofte HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Hasse Møller‐Sørensen
- Department of Cardiothoracic Anaesthesiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Rigshospitalet University of Copenhagen Copenhagen Denmark
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16
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Wetterslev M, Møller MH, Granholm A, Haase N, Hassager C, Lange T, Hästbacka J, Wilkman E, Myatra SN, Shen J, An Y, Siegemund M, Young PJ, Aslam TN, Szczeklik W, Aneman A, Arabi YM, Cronhjort M, Keus F, Perner A. New-onset atrial fibrillation in the intensive care unit: Protocol for an international inception cohort study (AFIB-ICU). Acta Anaesthesiol Scand 2021; 65:846-851. [PMID: 33864378 DOI: 10.1111/aas.13827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/03/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION New-onset atrial fibrillation (NOAF) is frequently observed in critically ill patients and may be associated with prolonged hospital stay and increased mortality. Considerable variation exists in the reported frequencies of NOAF due to the lack of a standardised definition and detection method. Importantly, there are limited data on NOAF in the intensive care unit (ICU). Thus, we aim to provide contemporary epidemiological data on NOAF in the ICU. METHODS AND ANALYSIS We have designed an international inception cohort study including at least 1,000 consecutive adult patients acutely admitted to the ICU without prior history of persistent or permanent AF. We will present data on the incidence, risk factors, used management strategies and outcomes of NOAF. We will register data daily during stay in the ICU for a maximum of 90 days after admission. The incidence of NOAF and management strategies used will be presented descriptively, and we will use Cox regression analyses including competing risk analyses to assess risk factors for NOAF and any association with 90-day mortality. CONCLUSION The outlined international AFIB-ICU inception cohort study will provide contemporary data on the incidence, risk factors, used management strategies and outcomes of NOAF in adult ICU patients. ETHICS AND DISSEMINATION This observational study poses no risk to the included patients. All participating sites will obtain relevant approvals according to national laws before patient enrollment. Funding sources will have no influence on data handling, analyses or writing of the manuscript. The study report(s) will be submitted to an international peer-reviewed journal.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | | | - Anders Granholm
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Theis Lange
- Department of Public Health Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Johanna Hästbacka
- Department of Anaesthesiology Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Erika Wilkman
- Department of Anaesthesiology Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Sheila Nainan Myatra
- Department of Anaesthesiology Critical Care and Pain Tata Memorial HospitalHomi Bhabha National Institute Mumbai India
| | - Jiawei Shen
- Department of Critical Care Medicine Peking University People's Hospital Beijing China
| | - Youzhong An
- Department of Critical Care Medicine Peking University People's Hospital Beijing China
| | - Martin Siegemund
- Department of Intensive Care Medicine and Department of Clinical Research University Hospital Basel and University of Basel Basel Switzerland
| | - Paul J Young
- Department of Intensive Care Wellington Regional Hospital Wellington New Zealand
- Royal Society Te Apārangi Medical Research Institute of New Zealand Wellington New Zealand
| | - Tayyba N. Aslam
- Department of Anaesthesiology Division of Emergencies and Critical Care Rikshospitalet Oslo University Hospital Oslo Norway
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
| | - Anders Aneman
- Department of Intensive Care Medicine Liverpool HospitalSouth Western Sydney Sydney Australia
- South Western Clinical School University of New South Wales Sydney Australia
| | - Yaseen M. Arabi
- Department of Intensive Care Medicine Ministry of National Guard Health AffairsKing Saud bin Abdulaziz University for Health SciencesKing Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Maria Cronhjort
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Frederik Keus
- Department of Critical Care University of GroningenUniversity Medical Center Groningen Groningen the Netherlands
| | - Anders Perner
- Department of Intensive Care University of Copenhagen Copenhagen Denmark
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17
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Li YG, Borgi M, Lip GYH. Atrial fibrillation occurring initially during acute medical illness: the heterogeneous nature of disease, outcomes and management strategies. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:567–569. [PMID: 30354185 PMCID: PMC8248833 DOI: 10.1177/2048872618801763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Yan-Guang Li
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Cardiology, Chinese PLA General Hospital, China
| | - Marco Borgi
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Cardiology, Chinese PLA General Hospital, China
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Denmark
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18
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Huynh JT, Healey JS, Um KJ, Vadakken ME, Rai AS, Conen D, Meyre P, Butt JH, Kamel H, Reza SJ, Nguyen ST, Oqab Z, Devereaux P, Balasubramanian K, Benz AP, Belley-Cote EP, McIntyre WF. Association Between Perioperative Atrial Fibrillation and Long-term Risks of Stroke and Death in Noncardiac Surgery: Systematic Review and Meta-analysis. CJC Open 2021; 3:666-674. [PMID: 34027371 PMCID: PMC8134907 DOI: 10.1016/j.cjco.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is frequently reported as a complication of noncardiac surgery. It is unknown whether new-onset perioperative AF is associated with an increased risk of stroke and death beyond the perioperative period. We performed a systematic review and meta-analysis to assess the long-term risks of stroke and mortality associated with new-onset perioperative AF after noncardiac surgery. METHODS MEDLINE and EMBASE were searched from inception to March 2020 for studies reporting on the association between perioperative AF and the risk of stroke and death occurring beyond 30 days after noncardiac surgery. Reference screening, study selection, data extraction, and quality assessment were performed in duplicate. Data were pooled using inverse variance-weighted random-effects models and presented as risk ratios (RRs). RESULTS From 7344 citations, we included 31 studies (3,529,493 patients). The weighted mean incidence of perioperative AF was 0.7%. During a mean follow-up of 28.1 ± 9.4 months, perioperative AF was associated with an increased risk of stroke (1.5 vs 0.9 strokes per 100 patient-years; RR: 2.9, 95% confidence interval [CI]: 2.1-3.9, I2 = 78%). Perioperative AF was also associated with a significantly higher risk of all-cause mortality (21.0 vs 7.6 deaths per 100 patient-years; RR: 1.8, 95% CI: 1.5-2.2, I2 = 94%). The pooled adjusted hazard ratios for stroke and all-cause mortality were 1.9 (95% CI: 1.6-2.2, I2 = 31%) and 1.5 (95% CI: 1.3-1.7, I2 = 20%), respectively. CONCLUSIONS Patients who had perioperative AF after noncardiac surgery had a higher long-term risk of stroke and mortality compared with patients who did not. Whether this risk is modifiable with oral anticoagulation therapy should be investigated.
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Affiliation(s)
- Jessica T. Huynh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S. Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kevin J. Um
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Maria E. Vadakken
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Anand S. Rai
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Pascal Meyre
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Jawad H. Butt
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hooman Kamel
- Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Seleman J. Reza
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie T. Nguyen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Zardasht Oqab
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - P.J. Devereaux
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander P. Benz
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Emilie P. Belley-Cote
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - William F. McIntyre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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19
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McIntyre WF, Vadakken ME, Rai AS, Thach T, Syed W, Um KJ, Ibrahim O, Dalmia S, Bhatnagar A, Mendoza PA, Benz AP, Bangdiwala SI, Spence J, McClure GR, Huynh JT, Zhang T, Inami T, Conen D, Devereaux PJ, Whitlock RP, Healey JS, Belley-Côté EP. Incidence and recurrence of new-onset atrial fibrillation detected during hospitalization for non-cardiac surgery: a systematic review and meta-analysis. Can J Anaesth 2021; 68:1045-1056. [PMID: 33624255 DOI: 10.1007/s12630-021-01944-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE This systematic review aimed to summarize reports of the incidence and long-term recurrence of new-onset atrial fibrillation (AF) associated with non-cardiac surgery. SOURCES We searched CENTRAL, MEDLINE and EMBASE from inception to November 2019. We included studies that reported on the incidence of new-onset perioperative AF during hospitalization for non-cardiac surgery and/or AF recurrence in such patients following discharge. Reviewers screened articles and abstracted data independently and in duplicate. We assessed study quality by appraising methodology for collecting AF history, incident AF during hospitalization, and AF recurrence after discharge. PRINCIPAL FINDINGS From 39,233 citations screened, 346 studies that enrolled a total of 5,829,758 patients met eligibility criteria. Only 27 studies used prospective, continuous inpatient electrocardiographic (ECG) monitoring to detect incident AF. Overall, the incidence of postoperative AF during hospitalization ranged from 0.004 to 50.3%, with a median [interquartile range] of 8.7 [3.8-15.0]%. Atrial fibrillation incidence varied with type of surgery. Prospective studies using continuous ECG monitoring reported significantly higher incidences of AF than those that did not (13.9% vs 1.9%, respectively; P < 0.001). A total of 13 studies (25,726 patients) with follow-up up to 5.4 years reported on AF recurrence following hospital discharge; only one study used a prospective systematic monitoring protocol. Recurrence rates ranged from 0 to 37.3%. CONCLUSIONS Rates of AF incidence first detected following non-cardiac surgery and long-term AF recurrence vary markedly. Differences in the intensity of ECG monitoring and type of surgery may account for this variation. TRIAL REGISTRATION PROSPERO (CRD42017068055); registered 1 September 2017.
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Affiliation(s)
- William F McIntyre
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Maria E Vadakken
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Anand S Rai
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Terry Thach
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Wajahat Syed
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kevin J Um
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Omar Ibrahim
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shreyash Dalmia
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Akash Bhatnagar
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Pablo A Mendoza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexander P Benz
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jessica Spence
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Graham R McClure
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jessica T Huynh
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tianyi Zhang
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Toru Inami
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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20
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McIntyre WF, Belley-Côté EP, Vadakken ME, Rai AS, Lengyel AP, Rochwerg B, Bhatnagar AK, Deif B, Um KJ, Spence J, Connolly SJ, Bangdiwala SI, Rao-Melacini P, Healey JS, Whitlock RP. High-Sensitivity Estimate of the Incidence of New-Onset Atrial Fibrillation in Critically Ill Patients. Crit Care Explor 2021; 3:e0311. [PMID: 33458680 PMCID: PMC7803666 DOI: 10.1097/cce.0000000000000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To estimate the incidence of new-onset atrial fibrillation in critically ill patients. DESIGN Prospective cohort. SETTING Medical-surgical ICU. SUBJECTS Consecutive patients without a history of atrial fibrillation but with atrial fibrillation risk factors. INTERVENTIONS Electrocardiogram patch monitor until discharge from hospital or up to 14 days. MEASUREMENTS AND MAIN RESULTS A total of 249 participants (median age of 71 yr [interquartile range] 64-78 yr; 35% female) completed the study protocol of which 158 (64%) were admitted to ICU for medical illness, 78 (31%) following noncardiac surgery, and 13 (5%) with trauma. Median Acute Physiology and Chronic Health Evaluation II score was 16 (interquartile range, 12-22). Median duration of patch electrocardiogram monitoring, ICU, and hospital lengths of stay were 6 (interquartile range, 3-12), 4 (interquartile range, 2-8), and 11 days (interquartile range, 5-23 d), respectively.Atrial fibrillation ≥ 30 seconds was detected by the patch in 44 participants (17.7%), and three participants (1.2%) had atrial fibrillation detected clinically after patch removal, resulting in an overall atrial fibrillation incidence of 18.9% (95% CI, 14.2-24.3%).Total duration of atrial fibrillation ranged from 53 seconds to the entire monitoring time. The proportion of participants with ≥1 episode(s) of ≥6 minute, ≥1 hour, ≥12 hour and ≥24 hour duration was 14.8%, 13.2%, 7.0%, and 5.3%, respectively. The clinical team recognized only 70% of atrial fibrillation cases that were detected by the electrocardiogram patch. CONCLUSIONS Among patients admitted to an ICU, the incidence of new-onset atrial fibrillation is approximately one in five, although approximately one-third of cases are not recognized by the clinical team.
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Affiliation(s)
- William F McIntyre
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Maria E Vadakken
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Anand S Rai
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Alexandra P Lengyel
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Akash K Bhatnagar
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Bishoy Deif
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Kevin J Um
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jessica Spence
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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21
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McIntyre WF, Wang J, Benz AP, Belley-Côté EP, Conen D, Devereaux PJ, Wong JA, Hohnloser SH, Capucci A, Lau CP, Gold MR, Israel CW, Whitlock RP, Connolly SJ, Healey JS. Device-Detected Atrial Fibrillation Before and After Hospitalisation for Noncardiac Surgery or Medical Illness: Insights From ASSERT. Can J Cardiol 2020; 37:803-809. [PMID: 33271225 DOI: 10.1016/j.cjca.2020.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is often detected during hospitalisation for surgery or medical illness and is often assumed to be due to the acute condition. METHODS The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT) study enrolled patients ≥ 65 years old without AF. Pacemakers or implantable cardioverter-defibrillators recorded device-detected AF. We identified participants who were hospitalised and compared the prevalence of AF before and after hospitalisation. RESULTS Among 2580 participants, 436 (16.9%) had a surgical or medical hospitalisation. In the 30 days following a first hospitalisation, 43 participants (9.9%, 95% confidence interval [CI] 7.2%-13.1%) had > 6 minutes of device-detected AF; 20 (4.6%, 95% CI 2.8%-7.0%) had > 6 hours. More participants had AF > 6 minutes in the 30 days following hospitalisation compared with the period 30-60 days before hospitalisation (9.9% vs 4.4%; P < 0.001). Similar results were observed for episodes > 6 hours (4.6% vs 2.3%, P = 0.03). Roughly half of participants with device-detected AF in the 30 days following hospitalisation had at least 1 episode of the same duration in the 6 months before (50% [95% CI 31.3%-68.7%] for > 6 min; 68.8% [95% CI 41.3%-89.0%] for > 6 h). Those with AF in the 30 days following hospitalisation were more likely to have had AF in the past (adjusted odds ratio [OR] 7.2, 95% CI 3.2-15.8 for > 6 min; adjusted OR 32.6, 95% CI 10.3-103.4 for > 6 h). CONCLUSIONS The prevalence of device-detected AF increases around the time of hospitalisation for noncardiac surgery or medical illness. About half of patients with AF around the time of hospitalisation previously had similar episodes.
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Affiliation(s)
- William F McIntyre
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
| | - Jia Wang
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander P Benz
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jorge A Wong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stefan H Hohnloser
- Department of Electrophysiology, J.W. Goethe University, Frankfurt, Germany
| | - Alessandro Capucci
- Department of Cardiovascular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China
| | - Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carsten W Israel
- Division of Cardiology, Department of Medicine, Evangelical Hospital Bielefeld, Bielefeld, Germany
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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22
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Falsetti L, Proietti M, Zaccone V, Guerra F, Nitti C, Salvi A, Viticchi G, Riccomi F, Sampaolesi M, Silvestrini M, Moroncini G, Lip GYH, Capucci A. Impact of atrial fibrillation in critically ill patients admitted to a stepdown unit. Eur J Clin Invest 2020; 50:e13317. [PMID: 32535903 DOI: 10.1111/eci.13317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/06/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Limited data are available on the clinical course of patients with history of atrial fibrillation (AF) when admitted in an intensive care environment. We aimed to describe the occurrence of major adverse events in AF patients admitted to a stepdown care unit (SDU) and to analyse clinical factors associated with outcomes, impact of dicumarolic oral anticoagulant (OAC) therapy impact and performance of clinical risk scores in this setting. MATERIALS AND METHODS Single-centre, observational retrospective analysis on a population of subjects with AF history admitted to a SDU. Therapeutic failure (composite of transfer to ICU or death) was considered the main study outcome. Occurrence of stroke and major bleeding (MH) was considered as secondary outcomes. The performance of clinical risk scores was evaluated. RESULTS A total of 1430 consecutive patients were enrolled. 194 (13.6%) reported the main outcome. Using multivariate logistic regression, age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01-1.05), acute coronary syndrome (OR:3.10, 95% CI: 1.88-5.12), cardiogenic shock (OR:10.06, 95% CI: 5.37-18.84), septic shock (OR:5.19,95%CI:3.29-18.84), acute respiratory failure (OR:2.49, 95% CI: 1.67-3.64) and OAC use (OR: 1.61, 95% CI: 1.02-2.55) were independently associated with main outcome. OAC prescription was associated with stroke risk reduction and to both MH and main outcome risk increase. CHA2 DS2 -VASc (c-index: 0.545, P = .117 for stroke) and HAS-BLED (c-index:0.503, P = .900 for MH) did not significantly predict events occurrence. CONCLUSIONS In critically ill AF patients admitted to a SDU, adverse outcomes are highly prevalent. OAC use is associated to an increased risk of therapeutic failure, clinical scores seem unhelpful in predicting stroke and MH, suggesting a highly individualized approach in AF management in this setting.
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Affiliation(s)
- Lorenzo Falsetti
- Internal and Sub-intensive Medicine Department, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Vincenzo Zaccone
- Internal and Sub-intensive Medicine Department, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Federico Guerra
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Cinzia Nitti
- Internal and Sub-intensive Medicine Department, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Aldo Salvi
- Internal and Sub-intensive Medicine Department, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Giovanna Viticchi
- Clinical and Experimental Medicine Department, Neurologic Clinic, Marche Polytechnic University, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Francesca Riccomi
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Mattia Sampaolesi
- Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Mauro Silvestrini
- Clinical and Experimental Medicine Department, Neurologic Clinic, Marche Polytechnic University, A.O.U. "Ospedali Riuniti", Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Alessandro Capucci
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, A.O.U. "Ospedali Riuniti", Ancona, Italy
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23
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Wetterslev M, Granholm A, Haase N, Hassager C, Hylander Møller M, Perner A. Treatment strategies for new-onset atrial fibrillation in critically ill patients: Protocol for a systematic review. Acta Anaesthesiol Scand 2020; 64:1343-1349. [PMID: 32673400 DOI: 10.1111/aas.13672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND New-onset atrial fibrillation is frequent in critically ill patients and associated with poorer outcomes in these patients. Numerous interventions are used for the management of new-onset atrial fibrillation, but it is unknown if these interventions improve patient-important outcomes as compared with placebo or no active intervention in adult critically ill patients. METHODS/DESIGN We will conduct a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing pharmacological and non-pharmacological interventions of new-onset atrial fibrillation as compared with placebo or no active intervention in adult critically ill patients. The primary outcomes are mortality, adverse events and health-related quality of life. We will search the following databases: MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, Science Citation Index and BIOSIS and follow the recommendations by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will evaluate the overall certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. DISCUSSION New-onset atrial fibrillation is common in adult critically ill patients. However, the balance between the desirable and undesirable effects of pharmacological and non-pharmacological interventions is unknown. The outlined systematic review aims to provide updated data on this topic. REGISTRATION Submitted to PROSPERO (CRD42020187178 ). Status: accepted.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark
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24
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Aibar J, Schulman S. New-Onset Atrial Fibrillation in Sepsis: A Narrative Review. Semin Thromb Hemost 2020; 47:18-25. [PMID: 32968991 DOI: 10.1055/s-0040-1714400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Atrial fibrillation (AF) is a frequently identified arrhythmia during the course of sepsis. The aim of this narrative review is to assess the characteristics of patients with new-onset AF related to sepsis and the risk of stroke and death, to understand if there is a need for anticoagulation. We searched for studies on AF and sepsis on PubMed, the Cochrane database, and Web of Science, and 17 studies were included. The mean incidence of new-onset AF in patients with sepsis was 20.6% (14.7% in retrospective studies and 31.6% in prospective). Risk factors for new-onset AF included advanced age, white race, male sex, obesity, history of cardiopulmonary disease, heart or respiratory failure, and higher disease severity score. In-hospital mortality was higher in patients with than in those without new-onset AF in 10 studies. In four studies the overall intensive care unit and hospital mortality rates were comparable between patients with and without new-onset AF, while three other studies did not provide mortality data. One study reported on the in-hospital incidence of stroke, which was 2.6 versus 0.69% in patients with or without new-onset AF, respectively. Seven of the studies provided follow-up data after discharge. In three studies, new-onset AF was associated with excess mortality at 28 days, 1 year, and 5 years after discharge of 34, 21, and 3% patients, respectively. In two studies, the mortality rate was comparable in patients with and without new-onset AF. Postdischarge stroke was reported in five studies, whereof two studies had no events after 30 and 90 days, one study showed a nonsignificant increase in stroke, and two studies demonstrated a significant increase in risk of stroke after new-onset AF. The absolute risk increase was 0.6 to 1.6%. Large prospective studies are needed to better understand the need for anticoagulation after new-onset AF in sepsis.
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Affiliation(s)
- Jesus Aibar
- Internal Medicine Department, Hospital Clínic, IDIBAPS - University of Barcelona, Spain.,Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sam Schulman
- Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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25
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Lowres N, Hillis GS, Gladman MA, Kol M, Rogers J, Chow V, Touma F, Barnes C, Auston J, Freedman B. Self-monitoring for recurrence of secondary atrial fibrillation following non-cardiac surgery or acute illness: A pilot study. IJC HEART & VASCULATURE 2020; 29:100566. [PMID: 32885031 PMCID: PMC7452573 DOI: 10.1016/j.ijcha.2020.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
Background Atrial fibrillation (AF) secondary to non-cardiac surgery and medical illness is common and, although often transient, is associated with an increased risk of stroke and mortality. This pilot study tested the feasibility of self-monitoring to detect recurrent AF in this setting and the frequency with which it occurred. Methods Patients with new secondary AF after non-cardiac surgery or medical illness that reverted to sinus rhythm before discharge were recruited in three tertiary hospitals in Australia. Participants performed self-monitoring for AF recurrence using a Handheld single-lead ECG device 3–4 times/day for 4-weeks. Results From 16,454 admissions, 224 (1.4%) secondary AF cases were identified. Of these, 94 were eligible, and 29 agreed to participate in self-monitoring (66% male; median age 67 years). Self-monitoring was feasible and acceptable to participants in this setting. Self-monitoring identified AF recurrence in 10 participants (34%; 95% CI, 18% −54%), with recurrence occurring ≤ 9 days following discharge in 9/10 participants. Only 4 participants (40%) reported associated palpitations with recurrence. Six participants (60%) with recurrence had a CHA2DS2-VA score ≥ 2, suggesting a potential indication for oral anticoagulation. Conclusions Approximately 1 in 3 patients with transient secondary AF will have recurrent AF within nine days of discharge. These recurrent episodes are often asymptomatic but can be detected promptly using patient self-monitoring, which was feasible and acceptable. Future research is warranted to further investigate the incidence of secondary AF, the rate of recurrence after discharge and its prognosis, and whether use of oral anticoagulation can reduce stroke in this setting.
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Affiliation(s)
- Nicole Lowres
- Heart Research Institute, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Australia.,Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Marc A Gladman
- Gastrointestinal & Enteric Neuroscience Research Group, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Mark Kol
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Intensive Care Services, Concord Repatriation General Hospital, Sydney, Australia
| | - Jim Rogers
- Department of Cardiology, Gosford Hospital, Gosford, Australia
| | - Vincent Chow
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Ferris Touma
- Department of Cardiology, Gosford Hospital, Gosford, Australia
| | - Cara Barnes
- Department of Cardiology, Royal Perth Hospital, Perth, Australia.,Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Joanne Auston
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
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26
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Yoshida T, Uchino S, Sasabuchi Y. Clinical course after identification of new-onset atrial fibrillation in critically ill patients: The AFTER-ICU study. J Crit Care 2020; 59:136-142. [PMID: 32674000 DOI: 10.1016/j.jcrc.2020.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Epidemiological information is lacking after identification of new-onset atrial fibrillation (AF) in critically ill patients. This study aimed to describe the clinical course after the identification of new-onset AF. MATERIALS AND METHODS This prospective cohort study enrolled adult patients with new-onset AF in 32 Japanese ICUs during 2017-2018. We collected data on patient comorbidities, physiological information before and at the AF onset, interventions for AF, cardiac rhythm transition, adverse events and in-hospital death and stroke. RESULTS We included 423 new-onset AF patients. At the AF onset, mean arterial pressure decreased and the heart rate increased. Eighty-four patients (20%) spontaneously restored sinus rhythm and 328 patients (78%) received various pharmacological interventions (rate-control drugs, 67%; rhythm-control drugs, 34%). Anticoagulants were administered in 173 patients (40%) and 13 patients (3%) experienced bleeding complications. Twenty-four patients (6%) were still in AF at 168 h after the onset (sustained AF 4%; recurrent AF 2%). The overall hospital mortality was 26% and the incidence of in-hospital stroke was 4.5%. CONCLUSIONS Although the proportion of patients with AF continued to decrease with various treatments, these patients had high risk of death. Further research to assess the management of new-onset AF in critically ill patients is warranted.
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Affiliation(s)
- Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan
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27
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Huang S, Sanfilippo F, Herpain A, Balik M, Chew M, Clau-Terré F, Corredor C, De Backer D, Fletcher N, Geri G, Mekontso-Dessap A, McLean A, Morelli A, Orde S, Petrinic T, Slama M, van der Horst ICC, Vignon P, Mayo P, Vieillard-Baron A. Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel. Ann Intensive Care 2020; 10:49. [PMID: 32335780 PMCID: PMC7183522 DOI: 10.1186/s13613-020-00662-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal. Methods We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other “topic-specific” items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item. Results From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure. Conclusion This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.
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Affiliation(s)
- S Huang
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - F Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - A Herpain
- Department of Intensive Care, Erasme University Hospital, Univeristé Libre de Bruxelles, Brussels, Belgium
| | - M Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Chew
- Department of Anaesthesiology and Intensive Care, Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - F Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Corredor
- Department of Perioperative Medicine, Bart's Heart Centre St. Bartholomew's Hospital, W. Smithfield, London, UK
| | - D De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - N Fletcher
- Cardiothoracic Critical Care, St Georges Hospital, St Georges University of London, London, UK
| | - G Geri
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - A Mekontso-Dessap
- Service de réanimation médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - A McLean
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - A Morelli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, "La Sapienza," Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - S Orde
- Intensive Care Unit, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - T Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - M Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - I C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, University Maastricht, Maastricht, The Netherlands
| | - P Vignon
- Medical-Surgical Intensive Care Unit, Limoges University Hospital, Inserm CIC 1435, Limoges, France
| | - P Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA
| | - A Vieillard-Baron
- Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. .,INSERM, UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif, France.
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28
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Hofer F, Kazem N, Hammer A, El-Hamid F, Koller L, Niessner A, Sulzgruber P. Long-term prognosis of de novo atrial fibrillation during acute myocardial infarction: the impact of anti-thrombotic treatment strategies. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:189-195. [PMID: 32289167 DOI: 10.1093/ehjcvp/pvaa027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/08/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
AIMS While the prognosis of patients presenting with de novo atrial fibrillation (AF) during the acute phase of myocardial infarction has been controversially discussed, it seems intuitive that affected individuals have an increased risk for both thrombo-embolic events and mortality. However, profound data on long-term outcome of this highly vulnerable patient population are not available in current literature. Therefore, we aimed to investigate the impact of de novo AF and associated anti-thrombotic treatment strategies on the patient outcome from a long-term perspective. METHODS AND RESULTS Patients presenting with acute myocardial infarction, treated at the Medical University of Vienna, were enrolled within a clinical registry and screened for the development of de novo AF. After discharge, participants were followed prospectively over a median time of 8.6 years. Primary study endpoint was defined as cardiovascular mortality. Out of 1372 enrolled individuals 149 (10.9%) developed de novo AF during the acute phase of acute myocardial infarction. After a median follow-up time of 8.6 years, a total of 418 (30.5%) died due to cardiovascular causes, including 93 (62.4%) in the de novo AF subgroup. We found that de novo AF was significantly associated with long-term cardiovascular mortality with an adjusted HR of 1.45 (95% CI 1.19-2.57; P < 0.001). While patients with de novo AF were less likely to receive a triple anti-thrombotic therapy as compared to patients with pre-existing AF at time of discharge, this therapeutic approach showed a strong and inverse association with mortality in de novo AF, with an adj. HR of 0.86 (95% CI 0.45-0.92; P = 0.012). CONCLUSION De novo AF was independently associated with a poor prognosis with a 67% increased risk of long-term cardiovascular mortality. Intensified anti-thrombotic treatment in this high-risk patient population might be considered.
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Affiliation(s)
- Felix Hofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Niema Kazem
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andreas Hammer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Feras El-Hamid
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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29
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Koshy AN, Hamilton G, Theuerle J, Teh AW, Han HC, Gow PJ, Lim HS, Thijs V, Farouque O. Postoperative Atrial Fibrillation Following Noncardiac Surgery Increases Risk of Stroke. Am J Med 2020; 133:311-322.e5. [PMID: 31473150 DOI: 10.1016/j.amjmed.2019.07.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND New-onset postoperative atrial fibrillation is well recognized to be an adverse prognostic marker in patients undergoing noncardiac surgery. Whether postoperative atrial fibrillation confers an increased risk of stroke remains unclear. METHODS A systematic review and meta-analysis was performed to assess the risk of stroke after postoperative atrial fibrillation in noncardiac surgery. MEDLINE, Cochrane, and EMBASE databases were searched for articles published up to May 2019 for studies of patients undergoing noncardiac surgery that reported incidence of new atrial fibrillation and stroke. Event rates from individual studies were pooled and risk ratios (RR) were pooled using a random-effects model. RESULTS Fourteen studies of 3,536,291 patients undergoing noncardiac surgery were included in the quantitative analysis (mean follow-up 1.4 ± 1 year). New atrial fibrillation occurred in 26,046 (0.74%), patients with a higher incidence following thoracic surgery. Stroke occurred in 279 (1.5%) and 6199 (0.4%) patients with and without postoperative atrial fibrillation, respectively. On pooled analysis, postoperative atrial fibrillation was associated with a significantly increased risk of stroke (RR 2.51; 95% confidence interval, 1.76-3.59), with moderate heterogeneity. The stroke risk was significantly higher with atrial fibrillation following nonthoracic, compared with thoracic, surgery (RR 3.09 vs RR 1.95; P = .01). CONCLUSION New postoperative atrial fibrillation following noncardiac surgery was associated with a 2.5-fold increase in the risk of stroke. This risk was highest among patients undergoing nonthoracic noncardiac surgery. Given the documented efficacy of newer anticoagulants, randomized controlled trials are warranted to assess whether they can reduce the risk of stroke in these patients.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Garry Hamilton
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - James Theuerle
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Paul J Gow
- Department of Medicine, The University of Melbourne, Victoria, Australia; Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Vincent Thijs
- Department of Medicine, The University of Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health and Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia.
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30
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McIntyre WF, Lengyel AP, Healey JS, Vadakken ME, Rai AS, Rochwerg B, Bhatnagar A, Deif B, Spence J, Bangdiwala SI, Belley-Côté EP, Whitlock RP. Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) incidence study. J Electrocardiol 2019; 57:95-99. [PMID: 31629099 DOI: 10.1016/j.jelectrocard.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is often detected for the first time in patients hospitalized for medical illness or non-cardiovascular surgery. AF occurring transiently with stress (AFOTS) describes this manifestation of AF, which may either be the result of a non-cardiac stressor, or existing paroxysmal AF that was not previously detected. Current estimates of AFOTS incidence are imprecise: ranging from 1 to 44%, owing to the marked heterogeneity in patient populations, identification and methods used to detect AFOTS. METHODS The prospective, two-centre epidemiological AFOTS Incidence study will enroll 250 consecutive participants without a history of AF but with at increased risk of AF (Age ≥ 65 or >50 with one risk factor for AF) admitted to intensive care units (ICUs) for medical illness or non-cardiac surgery. Upon admission, participants will wear an ECG patch monitor that will remain in place for 14 days, or until discharge from hospital. Patients' consent to participation is deferred for up to 72 h after admission. The primary endpoint is the incidence of AF lasting ≥30 s. The study is powered to detect an AF incidence of 17% ± 5%. RESULTS We conducted a vanguard feasibility study, and 55 participants have completed participation. The median duration of monitoring was seven days. AF was detected by the clinical team in 8 participants (14%; 95% Confidence Interval 7-26%). CONCLUSIONS The AFOTS Incidence study will employ a systematic and highly sensitive protocol for detecting AFOTS in medical illness and non-cardiac surgery ICU patients. This study is feasible and will provide a reliable estimate of the true incidence of AFOTS in this population.
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Affiliation(s)
- W F McIntyre
- Population Health Research Institute, McMaster University, Canada.
| | - A P Lengyel
- Population Health Research Institute, McMaster University, Canada
| | - J S Healey
- Population Health Research Institute, McMaster University, Canada
| | - M E Vadakken
- Population Health Research Institute, McMaster University, Canada
| | - A S Rai
- Population Health Research Institute, McMaster University, Canada
| | - B Rochwerg
- Population Health Research Institute, McMaster University, Canada
| | - A Bhatnagar
- Population Health Research Institute, McMaster University, Canada
| | - B Deif
- Population Health Research Institute, McMaster University, Canada
| | - J Spence
- Population Health Research Institute, McMaster University, Canada
| | - S I Bangdiwala
- Population Health Research Institute, McMaster University, Canada
| | - E P Belley-Côté
- Population Health Research Institute, McMaster University, Canada
| | - R P Whitlock
- Population Health Research Institute, McMaster University, Canada
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31
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[Atrial fibrillation in patients with sepsis and non-cardiac infections]. Herzschrittmacherther Elektrophysiol 2019; 30:256-261. [PMID: 31396698 DOI: 10.1007/s00399-019-0633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
Atrial fibrillation (AF) is by far the most frequent cardiac arrhythmia associated with sepsis and infections. Newly occurring AF due to infections is associated with a deterioration of the prognosis for acute events and also for the long-term prognosis of patients. The risk of developing AF during an infection depends on general (e.g. age, structural heart disease) as well as infection-specific risk factors (e.g. sepsis severity, vasopressor treatment). Current guidelines do not make specific recommendations on the treatment of infection-associated AF and very few prospective data are available. The use of beta blockers appears to be safe for both prevention and frequency control of AF even in patients requiring catecholamines. For specific antiarrhythmic treatment, the use of class I antiarrhythmic agents is conceivable as an alternative to the predominantly used amiodarone. Newly occurring AF within infections has long been considered a specific entity with a low risk of recurrence, so that only a small proportion of patients received long-term effective anticoagulation; however, data from large retrospective studies suggest significantly higher recurrence rates. Therefore, the question of whether this group of patients benefits from long-term effective anticoagulation and extended monitoring of arrhythmia should be the subject of future research.
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32
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New-onset atrial fibrillation in adult critically ill patients: a scoping review. Intensive Care Med 2019; 45:928-938. [DOI: 10.1007/s00134-019-05633-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/29/2019] [Indexed: 12/16/2022]
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Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study. Chest 2019; 156:518-528. [PMID: 31051171 DOI: 10.1016/j.chest.2019.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/23/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The long-term risks of thromboembolism and mortality are unknown in patients who survived following atrial fibrillation (AF) newly diagnosed during critical care. METHODS Using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for > 6 months following AF newly diagnosed during critical care (ICU-AF), 269,751 control subjects with non-ICU AF (AF-control), and 439,868 control subjects without AF (No-AF) from 2005 to 2013. We performed propensity score matching and compared the risks of stroke/systemic embolism and all-cause mortality. RESULTS The adjusted hazard ratios (HRs) for long-term stroke/systemic embolism in the patients with ICU-AF were 0.93 (95% CI, 0.88-0.98) compared with the AF-control group and 1.50 (95% CI, 1.42-1.60) compared with the No-AF group. The adjusted HRs of the ICU-AF group for long-term mortality were 1.73 (95% CI, 1.70-1.83) and 3.20 (95% CI, 3.08-3.33) compared with the AF-control and No-AF groups, respectively. The risks of stroke/systemic embolism and mortality were significantly higher in the ICU-AF group than in the No-AF group after excluding patients with AF recurrence (adjusted HR, 1.08; 95% CI, 1.01-1.17), regardless of the causes of critical care and cardiovascular or noncardiovascular surgery. CONCLUSIONS The patients who survived following AF newly diagnosed during critical care remained at a higher risk of long-term stroke/systemic embolism and mortality than the patients without AF regardless of AF recurrence and the causes of critical care. Close follow-up and continuous anticoagulation might be needed for these patients.
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Vrints CJ. Focus on cardiac arrhythmias and conduction disorders. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 8:101-103. [PMID: 30873842 DOI: 10.1177/2048872619839639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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McIntyre WF, Mendoza PA, Belley‐Côté EP, Whitlock RP, Um KJ, Maystrenko N, Devereaux P, Conen D, Wong JA, Connolly SJ, Healey JS. Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow-up cohort study. Clin Cardiol 2018; 41:1273-1280. [PMID: 30125047 PMCID: PMC6489868 DOI: 10.1002/clc.23053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/17/2023] Open
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.
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Affiliation(s)
- William F. McIntyre
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Pablo A. Mendoza
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Emilie P. Belley‐Côté
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
- Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Richard P. Whitlock
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
- Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Division of Cardiac Surgery, Department of SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Kevin J. Um
- Population Health Research InstituteHamiltonOntarioCanada
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | - P.J. Devereaux
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - David Conen
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Jorge A. Wong
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Stuart J. Connolly
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Jeff S. Healey
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
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