Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke

Abstract

IMPORTANCE Clinically apparent atrial fibrillation increases the risk of ischemic stroke. In contrast, perioperative atrial fibrillation may be viewed as a transient response to physiological stress, and the long-term risk of stroke after perioperative atrial fibrillation is unclear. OBJECTIVE To examine the association between perioperative atrial fibrillation and the long-term risk of stroke. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using administrative claims data on patients hospitalized for surgery (as defined by surgical diagnosis related group codes), and discharged alive and free of documented cerebrovascular disease or preexisting atrial fibrillation from nonfederal California acute care hospitals between 2007 and 2011. Patients undergoing cardiac vs other types of surgery were analyzed separately. MAIN OUTCOMES AND MEASURES Previously validated diagnosis codes were used to identify ischemic strokes after discharge from the index hospitalization for surgery. The primary predictor variable was atrial fibrillation newly diagnosed during the index hospitalization, as defined by previously validated present-on-admission codes. Patients were censored at postdischarge emergency department encounters or hospitalizations with a recorded diagnosis of atrial fibrillation. RESULTS Of 1 729 360 eligible patients, 24 711 (1.43%; 95% CI, 1.41%–1.45%) had new-onset perioperative atrial fibrillation during the index hospitalization and 13 952 (0.81%; 95% CI, 0.79%–0.82%) experienced a stroke after discharge. In a Cox proportional hazards analysis accounting for potential confounders, perioperative atrial fibrillation was associated with subsequent stroke both after noncardiac and cardiac surgery. Type of SurgeryCumulative Rate of Stroke 1 Year AfterHospitalization, % (95% CI)Hazard Ratio (95% CI)PerioperativeAtrial FibrillationNo PerioperativeAtrial FibrillationNoncardiac1.47 (1.24–1.75)0.36 (0.35–0.37)2.0 (1.7–2.3)Cardiac0.99 (0.81–1.20)0.83 (0.76–0.91)1.3 (1.1–1.6) The association with stroke was significantly stronger for perioperative atrial fibrillation after noncardiac vs cardiac surgery (P < .001 for interaction). CONCLUSIONS AND RELEVANCE Among patients hospitalized for surgery, perioperative atrial fibrillation was associated with an increased long-term risk of ischemic stroke, especially following noncardiac surgery.

Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation

“…Published claims‐based algorithms were used in defining outcomes and validated in previous studies 3, 14, 15, 16, 17. ICD‐9‐CM codes are given in Table 1.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Długoterminowo u pacjentów z epizodem AF w okresie pooperacyjnym stwierdza się 2-krotny wzrost umieralności z przyczyn sercowo-naczyniowych oraz znacznie zwiększone ryzyko AF i udaru niedokrwiennego w przyszłości w porównaniu z pacjentami, u których po operacji utrzymywał się rytm zatokowy [952][953][954][955][956][957][958]. Doustne leczenie przeciwzakrzepowe w momencie wypisania ze szpitala wią-zało się w odległej obserwacji ze zmniejszeniem umieralności u pacjentów z AF w okresie pooperacyjnym [959], choć nie ma dowodów z kontrolowanych prób klinicznych.…”

Atrial Fibrillation and Mortality in Critically Ill Patients: A Retrospective Study

“…6,[12][13][14][15][16][17] In a general population and in patients with congestive heart failure, according to data from the Framingham Heart Study, atrial fibrillation is associated with increased risk for death. 18,19 However, evidence on the outcome of atrial fibrillation in general ICU patients is limited and somewhat conflicting.…”