New-onset atrial fibrillation in adult critically ill patients: a scoping review

Wetterslev, Mik; Haase, Nicolai; Hassager, Christian; Belley‐Côté, Emilie P.; McIntyre, William F.; An, Youzhong; Shen, Jiawei; Cavalcanti, Alexandre Biasi; Zampieri, Fernando Godinho; Guimarães, Hélio Penna; Granholm, Anders; Perner, Anders; Møller, Morten Hylander

doi:10.1007/s00134-019-05633-x

Cited by 82 publications

(149 citation statements)

References 112 publications

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“…We identified NOAF in 10.3% of critically ill adults, in keeping with known prevalence rates [4]. We found no association between NOAF and increased hospital Patients with NOAF had prolonged ICU and hospital LOS, and NOAF was a predictor of increased total costs.…”

Section: Discussionsupporting

confidence: 74%

“…To adjust for measured confounders in the association between new-onset AF and outcomes of interest, we followed recommendations for observational studies in the critically ill [30]. As per these recommendations, confounders were determined a priori, on the basis of their likelihood of influencing both the presence of NOAF and mortality and not acting as mediators or colliders in the association between AF and mortality, as based upon existing clinical knowledge evaluating the association between NOAF and mortality in critically ill patients [3,4]. In accordance with these recommendations [30], we used multivariable logistic regression modeling to adjust for important continuous (age, MODS at ICU admission, Elixhauser comorbidity index) and categorical (sex, individual comorbidities, "No-CPR" directive on admission, location prior to ICU admission, and most responsible diagnosis) variables.…”

Section: Discussionmentioning

confidence: 99%

“…Patients identified through this method were then evaluated by a single investigator (SMF), to confirm the diagnosis. Since there is no consensus definition for NOAF [4], we followed pre-existing definitions from the literature [7,8]. NOAF was defined as either (1) AF ≥ 1 h in duration, as noted by bedside telemetry (routinely evaluated in charts where electrocardiograms were not completed); (2) AF < 1 h in duration, but captured on electrocardiogram; or (3) AF initiating pharmacologic therapy or electrical cardioversion.…”

Section: Screening For Atrial Fibrillationmentioning

confidence: 99%

“…In the intensive care unit (ICU), patients often present with pre-existing AF; however, some ICU patients may develop new-onset AF (NOAF) in the context of critical illness [3]. Unlike AF seen in non-critically ill patients, NOAF is often thought to be a consequence of critical illness pathophysiology and treatment, including inflammation, electrolyte disturbances, or proarrhythmic medications, namely vasopressors and inotropes [4]. Incidence of NOAF in the general ICU varies markedly; however, most studies suggest that 10-15% of patients will develop this complication during their ICU stay [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…The clinical importance of critical illness-associated NOAF is a matter of ongoing uncertainty [4]. AF in and of itself may contribute to clinical decompensation through hemodynamic compromise [6].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Screening For Atrial Fibrillationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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

et al. 2023

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ImportanceDexmedetomidine is a widely used sedative in the intensive care unit (ICU) and has unique properties that may be associated with reduced occurrence of new-onset atrial fibrillation (NOAF).ObjectiveTo investigate whether the use of dexmedetomidine is associated with the incidence of NOAF in patients with critical illness.Design, Setting, and ParticipantsThis propensity score–matched cohort study was conducted using the Medical Information Mart for Intensive Care-IV database, which includes records of patients admitted to the ICU at Beth Israel Deaconess Medical Center in Boston dating 2008 through 2019. Included patients were those aged 18 years or older and hospitalized in the ICU. Data were analyzed from March through May 2022.ExposurePatients were divided into 2 groups according to dexmedetomidine exposure: those who received dexmedetomidine within 48 hours after ICU admission (dexmedetomidine group) and those who never received dexmedetomidine (no dexmedetomidine group).Main Outcomes and MeasuresThe primary outcome was the occurrence of NOAF within 7 days of ICU admission, as defined by the nurse-recorded rhythm status. Secondary outcomes were ICU length of stay, hospital length of stay, and in-hospital mortality.ResultsThis study included 22 237 patients before matching (mean [SD] age, 65.9 [16.7] years; 12 350 male patients [55.5%]). After 1:3 propensity score matching, the cohort included 8015 patients (mean [SD] age, 61.0 [17.1] years; 5240 males [65.4%]), among whom 2106 and 5909 patients were in the dexmedetomidine and no dexmedetomidine groups, respectively. Use of dexmedetomidine was associated with a decreased risk of NOAF (371 patients [17.6%] vs 1323 patients [22.4%]; hazard ratio, 0.80; 95% CI, 0.71-0.90). Although patients in the dexmedetomidine group had longer median (IQR) length of stays in the ICU (4.0 [2.7-6.9] days vs 3.5 [2.5-5.9] days; P &lt; .001) and hospital (10.0 [6.6-16.3] days vs 8.8 [5.9-14.0] days; P &lt; .001), dexmedetomidine was associated with decreased risk of in-hospital mortality (132 deaths [6.3%] vs 758 deaths [12.8%]; hazard ratio, 0.43; 95% CI, 0.36-0.52).Conclusions and RelevanceThis study found that dexmedetomidine was associated with decreased risk of NOAF in patients with critical illness, suggesting that it may be necessary and warranted to evaluate this association in future clinical trials.

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New‐onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID‐19)

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et al. 2021

Journal of Arrhythmia

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Background Mortality in critically ill patients with coronavirus disease 2019 (COVID‐19) is high, therefore, it is essential to evaluate the independent effect of new‐onset atrial fibrillation (NOAF) on mortality in patients with COVID‐19. We aimed to determine the incidence, risk factors, and outcomes of NOAF in a cohort of critically ill patients with COVID‐19. Methods We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID‐19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID‐19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID‐19 patients. Results NOAF incidence was 14.9% (n = 37), and 78% of patients (n = 29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5‐84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, P = .019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40‐5.09, P = .582). Conclusions The incidence of NOAF was 14.9% in critically ill COVID‐19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID‐19.

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New-onset atrial fibrillation in adult critically ill patients: a scoping review

Cited by 82 publications

References 112 publications

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

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

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

New‐onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID‐19)

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