Post–Cardiac Surgery Atrial Fibrillation

Matos, Jason; Sellke, Frank W.; Zimetbaum, Peter

doi:10.1016/j.ccep.2020.11.011

Cited by 4 publications

(4 citation statements)

References 46 publications

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“…We also considered reason for hospitalization, as clinical decision‐making may differ for patients hospitalized primarily for atrial fibrillation or for other conditions that impact the risks of anticoagulation 33 . We classified patients into 5 clinical groups: hospitalized for atrial fibrillation, hospitalized for bleeding, hospitalized for cardiac surgery, hospitalized for other cardiovascular diagnoses, and all others (Table S1).…”

Section: Methodsmentioning

confidence: 99%

“…32 We also considered reason for hospitalization, as clinical decision-making may differ for patients hospitalized primarily for atrial fibrillation or for other conditions that impact the risks of anticoagulation. 33 We classified patients into 5 clinical groups: hospitalized for atrial fibrillation, hospitalized for bleeding, hospitalized for cardiac surgery, hospitalized for other cardiovascular diagnoses, and all others (Table S1). We evaluated those hospitalized for cardiac surgery separately as pathophysiology and guideline recommendations differ for atrial fibrillation post-cardiac surgery, and evaluated those hospitalized for cardiovascular conditions separately as those were more likely to have engaged with cardiovascular subspecialty clinicians during their admissions.…”

Section: Covariatesmentioning

confidence: 99%

“…We evaluated those hospitalized for cardiac surgery separately as pathophysiology and guideline recommendations differ for atrial fibrillation post-cardiac surgery, and evaluated those hospitalized for cardiovascular conditions separately as those were more likely to have engaged with cardiovascular subspecialty clinicians during their admissions. [33][34][35]…”

Section: Covariatesmentioning

confidence: 99%

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Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization

Troy

Herzig

Trivedi

et al. 2023

J American Geriatrics Society

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BackgroundAtrial fibrillation is a common cause of stroke among older adults and is often first detected during hospitalization, given frequent use of cardiac telemetry.MethodsIn a 20% national sample of Medicare fee‐for‐service beneficiaries, we identified patients aged 65‐or‐older newly diagnosed with atrial fibrillation while hospitalized in 2016. Our primary outcome was an oral anticoagulant claim within 7‐days of discharge. Multivariable logistic regression analyses assessed relationships between anticoagulation initiation and thromboembolic and bleeding risk scores while controlling for demographics, frailty, comorbidities, and hospitalization characteristics.ResultsAmong 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2 [SD 8.4]; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA2DS2‐VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% [95% CI, 18.7%–22.3%] for scores <2 and 24.9% [CI, 24.4%–25.4%] for ≥4). Elevated HAS‐BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% [CI, 24.4%–26.4%] for score <2 and 23.1% [CI, 22.5%–23.8%] for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% [CI, 23.2%–26.2%] for non‐frail and 18.1% [CI, 16.6%–19.6%] for moderately‐severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1% [CI, 45.0%–47.3%]) and lowest among those with non‐cardiovascular conditions (13.8% [CI, 13.3%–14.3%]) and bleeds (3.6% [CI, 2.4%–4.8%]).ConclusionsOral anticoagulant initiation is uncommon among older adults newly diagnosed with atrial fibrillation during hospitalization, even among patients hospitalized primarily for atrial fibrillation and patients with high thromboembolic risk. Clinicians should discuss risks and benefits of oral anticoagulants with all inpatients found to have atrial fibrillation.

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Section: Methodsmentioning

confidence: 99%

Section: Covariatesmentioning

confidence: 99%

Section: Covariatesmentioning

confidence: 99%

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Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization

Troy

Herzig

Trivedi

et al. 2023

J American Geriatrics Society

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“…The incidence of PoAF varies widely in the literature and ranges from 20 to 40%; moreover, the exact mechanism of pathophysiology has yet to be fully understood [11,12]. Although PoAF has been extensively researched in the past twenty years, advances in surgical care have not reduced the incidence of the associated complications arising from PoAF [6].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effects of Postoperative Atrial Fibrillation following Mitral Valve Surgery

Alghosoon

Arafat

Albabtain

et al. 2023

JCDD

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Background: New-onset postoperative atrial fibrillation (PoAF) is one of the most frequent yet serious complications following cardiac surgery. Long-term consequences have not been thoroughly investigated, and studies have included different cardiac operations. The objectives were to report the incidence and short- and long-term outcomes in patients with PoAF after mitral valve surgery. Methods: This is a retrospective cohort study of 1401 patients who underwent mitral valve surgery from 2009 to 2020. Patients were grouped according to the occurrence of PoAF (n = 236) and the nonoccurrence of PoAF (n = 1165). Long-term outcomes included mortality, heart failure rehospitalization, stroke, and mitral valve reinterventions. Results: The overall incidence of PoAF was 16.8%. PoAF was associated with higher rates of operative mortality (8.9% vs. 3.3%, p < 0.001), stroke (6.9% vs. 1.5%, p < 0.001), and dialysis (13.6% vs. 3.5%, p < 0.001). ICU and hospital stays were significantly longer in patients with PoAF (p < 0.001 for both). PoAF was significantly associated with an increased risk of mortality [HR: 1.613 (95% CI: 1.048–2.483); p = 0.03], heart failure rehospitalization [HR: 2.156 (95% CI: 1.276–3.642); p = 0.004], and stroke [HR: 2.722 (95% CI: 1.321–5.607); p = 0.007]. However, PoAF was not associated with increased mitral valve reinterventions [HR: 0.938 (95% CI: 0.422–2.087); p = 0.875]. Conclusions: Atrial fibrillation after mitral valve surgery is a common complication, with an increased risk of operative mortality. PoAF was associated with lower long-term survival, increased heart failure rehospitalization, and stroke risk. Future studies are needed to evaluate strategies that can be implemented to improve the outcomes of these patients.

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Incidence, predictors, and outcome for post-operative atrial fibrillation in Indian patients undergoing off-pump coronary artery bypass grafting—a prospective observational study

Potdar

Shales

Baviskar

et al. 2022

Indian J Thorac Cardiovasc Surg

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Post–Cardiac Surgery Atrial Fibrillation

Cited by 4 publications

References 46 publications

Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization

Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization

Long-Term Effects of Postoperative Atrial Fibrillation following Mitral Valve Surgery

Incidence, predictors, and outcome for post-operative atrial fibrillation in Indian patients undergoing off-pump coronary artery bypass grafting—a prospective observational study

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