Post-operative atrial fibrillation and risk of heart failure hospitalization

Goyal, Parag; Kim, Michael; Krishnan, Udhay; McCullough, Stephen; Cheung, Jim W.; Kim, Luke K.; Borlaug, Barry A.; Horn, Evelyn M.; Safford, Monika M.; Kamel, Hooman

doi:10.1093/eurheartj/ehac285

Cited by 25 publications

(14 citation statements)

References 23 publications

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“…An increased risk of heart failure hospitalization and AF recurrence in POAF patients, were observed in the present study. The increased risk for heart failure is in accordance with recent studies both in CABG patients [ 17 , 18 ] and in mixed cardiac surgery and non-cardiac surgery patients [ 19 ], but has not previously been reported after SAVR. AF and heart failure are closely related conditions with partly the same risk factors and pathophysiology.…”

Section: Discussionsupporting

confidence: 91%

Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement

Rezk

Taha

Nielsen

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Objectives Data on prognostic implications of new-onset postoperative atrial fibrillation (POAF) after surgical aortic valve replacement (SAVR) is limited. We sought to explore associations between POAF, early-initiated oral anticoagulation (OAC), and long-term outcome after SAVR and combined SAVR+CABG. Methods This is a retrospective, population-based study including all isolated SAVR (n = 7038) and combined SAVR and CABG patients (n = 3854) without a history of preoperative atrial fibrillation in Sweden 2007–2017. Individual patient data was merged from four nationwide registries. Inverse Probability of Treatment Weighting (IPTW) adjusted Cox regression models were employed separately in SAVR and SAVR+CABG patients. Median follow-up time was 4.7 years (range 0–10 years). Results POAF occurred in 44.5% and 50.7% of SAVR and SAVR+CABG patients, respectively. In SAVR patients, POAF was associated with increased long-term risk of death [adjusted hazard ratio (aHR) 1.21 (95% confidence interval 1.06–1.37)], ischaemic stroke [aHR 1.32 (1.08–1.59)], any thromboembolism, heart failure hospitalization, and recurrent atrial fibrillation. In SAVR+CABG, POAF was associated with death [aHR 1.31 (1.14–1.51)], recurrent atrial fibrillation, and heart failure, but not with ischaemic stroke [aHR 1.04 (0.84–1.29)] or thromboembolism. OAC was dispensed within 30 days after discharge to 67.0% and 65.9% respectively of SAVR and SAVR+CABG patients with POAF. Early initiated OAC was not associated with reduced risk of death, ischaemic stroke or thromboembolism in any group of patients. Conclusions POAF after SAVR is associated with an increased risk of long-term mortality and morbidity. Further studies are warranted to clarify the role of OAC in SAVR patients with POAF.

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Section: Discussionsupporting

confidence: 91%

Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement

Rezk

Taha

Nielsen

et al. 2023

European Journal of Cardio-Thoracic Surgery

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“…Patients with POAF after cardiac surgery are 30% more likely to be readmitted to hospital in the month after surgery (5)(6)(7)(8). Despite the uncertainty in efficacy as outlined in the previous section, rhythm control remains the most-used strategy during this phase of care.…”

Section: Short-term (First 1-3 Months) Therapy Post Dischargementioning

confidence: 99%

“…Patients who develop POAF have strokes at roughly four times the rate as those who do not and twice as likely to die (4)(5)(6). Patients with POAF spend longer in hospital, including up to 2 days more in the intensive care unit and an additional 3 days the hospital overall (5)(6)(7)(8). Moreover, they are 30% more likely to be readmitted to hospital in the month after surgery (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with POAF spend longer in hospital, including up to 2 days more in the intensive care unit and an additional 3 days the hospital overall (5)(6)(7)(8). Moreover, they are 30% more likely to be readmitted to hospital in the month after surgery (5)(6)(7)(8). In the early years following surgery, patients who had POAF experience a 2-to-4 fold increase in their risk of stroke and a 25% increase in the risk of death (5,9).…”

Section: Introductionmentioning

confidence: 99%

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Post-operative atrial fibrillation after cardiac surgery: Challenges throughout the patient journey

McIntyre

2023

Front. Cardiovasc. Med.

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Atrial fibrillation (AF) is the most common complication of cardiac surgery, occurring in up to half of patients. Post-operative AF (POAF) refers to new-onset AF in a patient without a history of AF that occurs within the first 4 weeks after cardiac surgery. POAF is associated with short-term mortality and morbidity, but its long-term significance is unclear. This article reviews existing evidence and research challenges for the management of POAF in patients who have had cardiac surgery. Specific challenges are discussed in four phases of care. Pre-operatively, clinicians need to be able to identify high-risk patients, and initiate prophylaxis to prevent POAF. In hospital, when POAF is detected, clinicians need to manage symptoms, stabilize hemodynamics and prevent increases in length of stay. In the month after discharge, the focus is on minimizing symptoms and preventing readmission. Some patients require short term oral anticoagulation for stroke prevention. Over the long term (2–3 months after surgery and beyond), clinicians need to identify which patients with POAF have paroxysmal or persistent AF and can benefit from evidence-based therapies for AF, including long-term oral anticoagulation.

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“…The clinical assessment should also consider that history of AF and the occurrence of POAF may have long-term implications for patient outcome 6 both in the case of cardiac surgery and in noncardiac surgery, with a potentially negative impact on survival, 3,7 stroke and hospitalization for heart failure. 5 Due to the higher number of noncardiac surgical interventions worldwide, AF in that setting appears to be an issue that deserves additional evaluations for the potential need for additional medical resources, increased costs and outcome implications.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

Malavasi,

Muto,

Ceresoli

et al. 2023

Journal of Cardiovascular Medicine

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Aims To know the prevalence of atrial fibrillation (AF), as well as the incidence of postoperative AF (POAF) in vascular surgery for arterial diseases and its outcome implications. Methods We performed a systematic review and meta-analysis following the PRISMA statement. Results After the selection process, we analyzed 44 records (30 for the prevalence of AF history and 14 for the incidence of POAF). The prevalence of history of AF was 11.5% [95% confidence interval (CI) 1–13.3] with high heterogeneity (I 2 = 100%). Prevalence was higher in the case of endovascular procedures. History of AF was associated with a worse outcome in terms of in-hospital death [odds ratio (OR) 3.29; 95% CI 2.66–4.06; P < 0.0001; I 2 94%] or stroke (OR 1.61; 95% CI 1.39–1.86; P < 0.0001; I 2 91%). The pooled incidence of POAF was 3.6% (95% CI 2–6.4) with high heterogeneity (I 2 = 100%). POAF risk was associated with older age (mean difference 4.67 years, 95% CI 2.38–6.96; P = 0.00007). The risk of POAF was lower in patients treated with endovascular procedures as compared with an open surgical procedure (OR 0.35; 95% CI 0.13–0.91; P = 0.03; I 2 = 61%). Conclusions In the setting of vascular surgery for arterial diseases a history of AF is found overall in 11.5% of patients, more frequently in the case of endovascular procedures, and is associated with worse outcomes in terms of short-term mortality and stroke. The incidence of POAF is overall 3.6%, and is lower in patients treated with an endovascular procedure as compared with open surgery procedures. The need for oral anticoagulants for preventing AF-related stroke should be evaluated with randomized clinical trials.

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Post-operative atrial fibrillation and risk of heart failure hospitalization

Cited by 25 publications

References 23 publications

Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement

Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement

Post-operative atrial fibrillation after cardiac surgery: Challenges throughout the patient journey

Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

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