Duration of Postoperative Atrial Fibrillation After Cardiac Surgery Is Associated With Worsened Long-Term Survival

Abstract

Background. Studies of the effects of postoperative atrial fibrillation (poAF) on long-term survival are conflicting, likely because of comorbidities that occur with poAF and the patient populations studied. Furthermore, the effects of poAF duration on long-term survival are poorly understood. Methods. We utilized a prospectively collected data-base on outcomes of cardiac surgery at a large tertiary care institution between August 2001 and December 2010 with survival follow-up through June 2015 to analyze long-term survival of patients with poAF. In addition, we identified patient- and procedure-related variables associated with poAF, and estimated overall comorbidity burden using the Elixhauser comorbidity index. Survival was compared between patients with poAF (n [ 513) and a propensity score matched control cohort, both for all patients and separately for subgroups of patients with poAF lasting less than 2 days (n [ 218) and patients with prolonged poAF (n [ 265). Results. Patients with poAF were older and had a higher burden of comorbidities. Survival was significantly worse for patients with poAF than for the matched control group (hazard ratio 1.43, 95% confidence interval: 1.11 to 1.86). That was driven by decreased survival among patients with prolonged poAF (hazard ratio 1.97, 95% confidence interval: 1.37 to 2.80), whereas survival of patients with poAF for less than 2 days was not significantly different from that of matched controls (hazard ratio 0.91, 95% confidence interval: 0.60 to 1.39). Conclusions. After close matching based on comorbidity burden, prolonged poAF is still associated with decreased survival. Therefore, vigilance is warranted in monitoring and treating patients with prolonged poAF after cardiac surgery.

Preoperative P-wave duration as a predictor of atrial fibrillation after coronary artery bypass grafting: A prospective cohort study with meta-analysis

“…Atrial fibrillation (AF) is one of the most common arrhythmic complications following coronary artery bypass grafting (CABG) surgery, with an incidence varying from 20% to 36% [ [1] , [2] , [3] ].Postoperative AF (POAF) is associated with significant morbidity, increased mortality, longer hospital stay and higher hospital costs [ 1 , 2 , [4] , [5] , [6] ]. In general, prophylactic medical therapies decrease the incidence of POAF, but the results in about 64%–84% of post-CABG patients receiving unnecessary treatment [ 7 , 8 ].…”

Predictive ability of perioperative atrial fibrillation risk indices in cardiac surgery patients: a retrospective cohort study

“…In addition, patients experiencing POAF have an increased long-term risk of chronic atrial fibrillation 28 and decreased long-term survival after cardiac surgery. 7,29 Importantly, strategies to reduce POAF have been associated with reduced hospital LOS, 4 healthcare costs, 4,30 and incidence of stroke, 31 suggesting the importance of POAF as a major morbid event after cardiac surgery. Nevertheless, strategies to prevent POAF have not appreciably changed the incidence of POAF over the past decade.…”

Invited Commentary

“…In this issue of The Annals, Sigurdsson and colleagues [2] are to be congratulated on their efforts to quantify the negative effects of poAF on long-term survival in cardiac surgery patients. Their data add to the growing body of evidence that poAF is associated with deleterious consequences.…”