New-Onset Atrial Fibrillation Is an Independent Predictor of Mortality in Medical Intensive Care Unit Patients

Chen, Alyssa Y.; Sokol, Sarah; Kress, John P.; Lat, Ishaq

doi:10.1177/1060028015574726

Cited by 57 publications

(47 citation statements)

References 22 publications

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“…In a study investigating patients with sepsis, those who developed NOAF had a hospital mortality rate of 44% versus 22% for those who did not (9). In a study of surgical ICU patients, hospital mortality was 45% for individuals with NOAF versus 16% for those without (4). Finally, in a cohort of trauma patients, individuals with NOAF had a mortality rate two times that of those without; however, the standardized mortality ratio (observed/expected mortality by severity of illness) was similar in the two groups, suggesting that NOAF was a marker of more severe illness (10).…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

“…The incidence of NOAF ranges from 5% to 46% (1)(2)(3). It is associated with significant morbidity and mortality (4)(5)(6), and clinicians treating patients in the intensive care unit (ICU) need to be aware of management options. Therapeutic strategies extrapolated from studies involving noncritically ill patients may not be generalizable to the critically ill; unfortunately, there are limited data from this population.…”

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confidence: 99%

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New-Onset Atrial Fibrillation in Critically Ill Patients

Sibley

Muscedere

2015

Canadian Respiratory Journal

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New-onset atrial fibrillation is a common problem in critically ill patients, with reported incidence ranging from 5% to 46%. It is associated with significant morbidity and mortality. The present review summarizes studies investigating new-onset atrial fibrillation conducted in the critical care setting, focusing on the etiology, management of the hemodynamically unstable patient, rate versus rhythm control, ischemic stroke risk and anticoagulation. Recommendations for an approach to management in the intensive care unit are drawn from the results of these studies.

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Section: Morbidity and Mortalitymentioning

confidence: 99%

mentioning

confidence: 99%

New-Onset Atrial Fibrillation in Critically Ill Patients

Sibley

Muscedere

2015

Canadian Respiratory Journal

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“…NOAF can lead to haemodynamic instability5 and thromboembolic events 6. Critically ill patients with NOAF experience longer intensive care unit (ICU) stay, greater duration of mechanical ventilation and an increased risk of in-hospital mortality 4 7 8…”

Section: Introductionmentioning

confidence: 99%

Managing new-onset atrial fibrillation in critically ill patients: a systematic narrative review

et al. 2020

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ObjectivesThe aim of this review is to summarise the latest evidence on efficacy and safety of treatments for new-onset atrial fibrillation (NOAF) in critical illness.ParticipantsCritically ill adult patients who developed NOAF during admission.Primary and secondary outcomesPrimary outcomes were efficacy in achieving rate or rhythm control, as defined in each study. Secondary outcomes included mortality, stroke, bleeding and adverse events.MethodsWe searched MEDLINE, EMBASE and Web of Knowledge on 11 March 2019 to identify randomised controlled trials (RCTs) and observational studies reporting treatment efficacy for NOAF in critically ill patients. Data were extracted, and quality assessment was performed using the Cochrane Risk of Bias Tool, and an adapted Newcastle-Ottawa Scale.ResultsOf 1406 studies identified, 16 remained after full-text screening including two RCTs. Study quality was generally low due to a lack of randomisation, absence of blinding and small cohorts. Amiodarone was the most commonly studied agent (10 studies), followed by beta-blockers (8), calcium channel blockers (6) and magnesium (3). Rates of successful rhythm control using amiodarone varied from 30.0% to 95.2%, beta-blockers from 31.8% to 92.3%, calcium channel blockers from 30.0% to 87.1% and magnesium from 55.2% to 77.8%. Adverse effects of treatment were rarely reported (five studies).ConclusionThe reported efficacy of beta-blockers, calcium channel blockers, magnesium and amiodarone for achieving rhythm control was highly varied. As there is currently significant variation in how NOAF is managed in critically ill patients, we recommend future research focuses on comparing the efficacy and safety of amiodarone, beta-blockers and magnesium. Further research is needed to inform the decision surrounding anticoagulant use in this patient group.

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“…A meta-analysis has shown that patients with sepsis who developed new-onset AF have higher mortality (11). Studies done in the ICU have shown that critically ill patients with new-onset AF have higher mortality and longer hospital stay (12)(13)(14)(15)(16). AF is also associated with mechanical ventilator weaning failure (17).…”

Section: Discussionmentioning

confidence: 99%

New-onset Atrial Fibrillation In Sepsis No Correlation With Inflammatory Cytokines in Real-life Clinical Setting

Li¹,

Li²,

Chai³

et al. 2020

Preprint

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Background New-onset atrial fibrillation(new-onset AF) is one of the most common tachyarrhythmia in critically ill patients and is associated with increased morbidity and mortality. Unfortunately, risk factors for new-onset AF in sepsis have not been clearly elucidated. This study aims to determine the association of new-onset AF with circulating inflammatory cytokine concentrations. Methods This is a retrospective analysis of the relationship between new-onset AF in sepsis and inflammatory cytokine concentrations. The study included patients with sepsis diagnosed in the Emergency Intensive Care Unit(EICU) of The First Affiliated Hospital of Xinjiang Medical University. This study was conducted on data submitted from June 2016 through May 2019. The patients were classified based on the new-onset AF into Control group(n = 100)、Non New-onset AF in sepsis group(n = 182)、New-onset AF in sepsis group(n = 89). We aimed to investigate whether new-onset AF in sepsis can be explained by increased circulating inflammatory cytokine concentrations. Results Unadjusted analysis of the 371 observations from the retrospective cohort study demonstrated that serum cytokine concentrations do not correlate with new-onset AF in sepsis, despite the fact that cytokines predict mortality and correlate with organ dysfunction and sepsis severity (APACHEⅡ and SOFA scores). On multivariable analysis, the present study shows that hypertension, BMI, fibrinogen and hs-Troponin-T strongly correlated with the new-onset AF in sepsis. Besides, none of the cytokine concentrations correlated with any of the hs-Troponin-T or fibrinogen. Conclusions Our study shows that risk factors for new-onset AF in sepsis are mainly factors that are associated with the pre-admission comorbidity, coagulation, cardiac biomarkers. none of the measured inflammatory cytokines correlates with new-onset AF in sepsis.

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New-Onset Atrial Fibrillation Is an Independent Predictor of Mortality in Medical Intensive Care Unit Patients

Abstract: Medical ICU patients who developed new-onset AF experienced a 2-fold increase in the odds of in-hospital mortality and death at 60 days. Further research investigating contributing factors to new-onset AF and potential treatments is warranted.

Cited by 57 publications

References 22 publications

New-Onset Atrial Fibrillation in Critically Ill Patients

New-Onset Atrial Fibrillation in Critically Ill Patients

Managing new-onset atrial fibrillation in critically ill patients: a systematic narrative review

New-onset Atrial Fibrillation In Sepsis No Correlation With Inflammatory Cytokines in Real-life Clinical Setting

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