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Atrial Fibrillation in critically ill patients: incidence and outcomes
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Abstract
Background: Atrial fibrillation (AF), either chronic or new onset, is common in critically ill patients. Its epidemiology and relationship with clinical outcomes are poorly known. Objective: To understand the burden of AF in patients admitted to ICU and its impact on patients’ outcomes. Methods: Single-center retrospective, cohort study, evaluating all patients with AF admitted to a non cardiac intensive care unit over the course of 54 months. Clinical outcomes were evaluated in the short (hospital discharge) and long-term (2-year follow-up). The hazard ratio (HR) with 95% CI was computed for the whole population as well as for propensity score-matched patients, with or without AF. Results: A total of 1357 patients were screened (59.1% male), with a mean age of 75±15.2 years, length of intensive care unit stay of 4.7±5.1 days, and hospital mortality of 26%. A diagnosis of AF was found in 215 patients (15.8%), 142 of which had chronic AF. The hospital all-cause mortality was similar in patients with chronic or new-onset AF (31% vs. 28.8%, p=0.779). Patients with AF had higher in-hospital, 1-year, and 2-year mortality (30.2%, 47.9%, and 52.6% vs. 22.9%, 35.3%, and 38.4%, respectively). However, after propensity score matching (N=213), this difference was no longer significant, neither in-hospital mortality (Odds Ratio 1.10; 95% CI 0.72-1.66), 1-year mortality (OR 1.16; 95% CI 0.79-1.70) or 2-years mortality, (Odds Ratio 1.16; 95% CI 0.79-1.70). Conclusions: In ICU patients AF was common, either chronic or new-onset, being diagnosed in 15.8%. Patients with AF had higher mortality but no significant differences were found in the short- and long-term mortality after adjustment for severity on admission.