Risk factors and outcomes of new-onset atrial fibrillation in patients hospitalized in an internal medicine ward: a case–control study

Para, Ombretta; Caruso, Lorenzo; Bacci, Francesca; Pasqui, Niccolò; Pieralli, Filippo; Ciarambino, Tiziana; Nozzoli, Carlo

doi:10.1007/s11739-019-02151-y

Cited by 7 publications

(12 citation statements)

References 35 publications

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“…Thirteen studies were held in North America [12,[18][19][20][21][22]28,31,33,34,[36][37][38], seven in Europe or the Middle East [23,[25][26][27]29,32,35], and two in Asia [24,29]. Fourteen studies were retrospective [18][19][20][21][22]25,26,28,29,[31][32][33][34]38], five were single-center observational [23,24,30,35,36], two studies were based on administrative databases [12,37], and one was a multicenter observational study [27]. As for the number of included patients with sepsis, 8 studies enrolled more than 1000 patients [12,18,19,22,…”

Section: Systematic Review Of the Included Studiesmentioning

confidence: 99%

Prevalence of New-Onset Atrial Fibrillation and Associated Outcomes in Patients with Sepsis: A Systematic Review and Meta-Analysis

Corica

Romiti

Basili

et al. 2022

JPM

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Background: New-onset atrial fibrillation (NOAF) is a common complication in patients with sepsis, although its prevalence and impact on outcomes are still unclear. We aim to provide a systematic review and meta-analysis on the prevalence of NOAF in patients with sepsis, and its impact on in-hospital mortality and intensive care unit (ICU) mortality. Methods: PubMed and EMBASE were systematically searched on 26 December 2021. Studies reporting on the prevalence of NOAF and/or its impact on in-hospital mortality or ICU mortality in patients with sepsis or septic shock were included. The pooled prevalence and 95% confidence intervals (CI) were calculated, as well as the risk ratios (RR), 95%CI and 95% prediction intervals (PI) for outcomes. Subgroup analyses and meta-regressions were performed to account for heterogeneity. Results: Among 4988 records retrieved from the literature search, 22 articles were included. Across 207,847 patients with sepsis, NOAF was found in 13.5% (95%CI: 8.9–20.1%), with high heterogeneity between studies; significant subgroup differences were observed, according to the geographical location, study design and sample size of the included studies. A multivariable meta-regression model showed that sample size and geographical location account for most of the heterogeneity. NOAF patients showed an increased risk of both in-hospital mortality (RR: 1.69, 95%CI: 1.47–1.96, 95%PI: 1.15–2.50) and ICU mortality (RR: 2.12, 95%CI: 1.86–2.43, 95%PI: 1.71–2.63), with moderate to no heterogeneity between the included studies. Conclusions: NOAF is a common complication during sepsis, being present in one out of seven individuals. Patients with NOAF are at a higher risk of adverse events during sepsis, and may need specific therapeutical interventions.

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Section: Systematic Review Of the Included Studiesmentioning

confidence: 99%

Prevalence of New-Onset Atrial Fibrillation and Associated Outcomes in Patients with Sepsis: A Systematic Review and Meta-Analysis

Corica

Romiti

Basili

et al. 2022

JPM

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“…Management of atrial fibrillation (AF) remains challenging, in consideration of its epidemiological profile and the risk of stroke and other adverse outcomes [1][2][3][4][5][6]. In the past, Gregory Y. H. Lip and Giuseppe Boriani joint senior authors.…”

Section: Introductionmentioning

confidence: 99%

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort

et al. 2021

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The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] was recently proposed to characterize AF patients. In this post hoc analysis we evaluated the agreement between the therapeutic strategy (rate or rhythm control, respectively), as suggested by the 4S-AF scheme, and the actual strategy followed in a patients cohort. Outcomes of interest were as follows: all-cause death, a composite of all-cause death/any thromboembolism/acute coronary syndrome, and a composite of all-cause death, any thrombotic/ischemic event, and major bleeding (net clinical outcome). We enrolled 615 patients: 60.5% male, median age 74 [interquartile range (IQR) 67-80] years; median CHA 2 DS 2 VASc 4 and median HAS-BLED 2. The 4S-AF score would have suggested a rhythm-control strategy in 351 (57.1%) patients while a rate control in 264 (42.9%). The strategy adopted was concordant with the 4S-AF suggestions in 342 (55.6%) cases, and non-concordant in 273 (44.4%). After a median follow-up of 941 days (IQR 365-1282), 113 (18.4%) patients died, 158 (25.7%) had an event of the composite endpoint. On adjusted Cox regression analysis, when 4S-AF score suggested rate control, disagreement with that suggestion was not associated with a worse outcome. When 4S-AF indicated rhythm control, disagreement was associated with a higher risk of all-cause death (HR 7.59; 95% CI 1.65-35.01), and of the composite outcome (HR 2.69; 95% CI 1.19-6.06). The 4S-AF scheme is a useful tool to comprehensively evaluate AF patients and aid the decision-making process. Disagreement with the rhythm control suggestion of the 4S-AF scheme was associated with adverse clinical outcomes.

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“…Moreover, these episodes are associated with high rates of recurrences and adverse outcomes, including increased in-hospital mortality [ 7 , 9 ]. Given that these clinical conditions are frequently observed in patients hospitalized at the Internal Medicine wards [ 8 ], it is of note that the good performance of the Microlife WatchBP Office AFIB device for new-onset AF screening makes this technology particularly suitable for the routine daily assessment of vital parameters in this clinical setting. Moreover, as opposite to pulse palpation, this screening technology is operator independent, does not require adequate training, and ideally would be highly effective in favouring a prompt AF diagnosis and a timely administration of anticoagulant drugs in patients where indicated, without any additional cost.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, frequently, the onset of AF complicates the clinical course of hospitalized patients admitted to Internal Medicine wards. Indeed, such patients have been found to have a higher rate of new-onset AF during the entire length of hospital stay [ 8 , 9 ], including asymptomatic episodes. This is of relevance, given that new-onset AF prolongs the course of hospitalization, and it is independently associated with adverse prognosis [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Screening for atrial fibrillation during automated blood pressure measurement among patients admitted to internal medicine ward

et al. 2021

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Atrial fibrillation (AF), the commonest sustained cardiac arrhythmia affecting the adult population, is often casually discovered among hospitalized people. AF onset is indeed triggered by several clinical conditions such as acute inflammatory states, infections, and electrolyte disturbance, frequently occurring during the hospitalization. We aimed to evaluate whether systematic AF screening, performed through an automated oscillometric blood pressure (BP) device (Microlife WatchBP Office AFIB, Microlife AG, Switzerland), is effective for detecting AF episodes in subjects admitted to an Internal Medicine ward. 163 patients consecutively hospitalized at the Unit of Internal Medicine of the “Santa Maria” Terni University Hospital between November 2019 and January 2020 (mean age ± standard deviation: 77 ± 14 years, men proportion: 40%) were examined. Simultaneously with BP measurement and AF screening, a standard 12-lead electrocardiogram (ECG) was performed in all subjects. AF was diagnosed by ECG in 29 patients (18%). AF screening showed overall 86% sensitivity and 96% specificity. False negatives (n = 4) had RR-interval coefficient of variation lower than true positives (n = 25, p < 0.01), suggesting a regular ventricular rhythm during AF. The repeated evaluation substantially confirmed the same level of agreement. AF screening was positive in all patients with new-onset AF (n = 6, 100%). Systematic AF screening in patients admitted to Internal Medicine wards, performed using the Microlife WatchBP Office AFIB, is feasible and effective. The opportunity to implement such technology in daily routine clinical practice to prevent undiagnosed AF episodes in hospitalized patients should be the subject of further research.

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Risk factors and outcomes of new-onset atrial fibrillation in patients hospitalized in an internal medicine ward: a case–control study

Cited by 7 publications

References 35 publications

Prevalence of New-Onset Atrial Fibrillation and Associated Outcomes in Patients with Sepsis: A Systematic Review and Meta-Analysis

Prevalence of New-Onset Atrial Fibrillation and Associated Outcomes in Patients with Sepsis: A Systematic Review and Meta-Analysis

Rhythm- or rate-control strategies according to 4S-AF characterization scheme and long-term outcomes in atrial fibrillation patients: the FAMo (Fibrillazione Atriale in Modena) cohort

Screening for atrial fibrillation during automated blood pressure measurement among patients admitted to internal medicine ward

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