Hospital outcomes associated with new-onset atrial fibrillation during ICU admission: A multicentre competing risks analysis |
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| Institution: | 1. Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA;2. Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA;3. Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH, USA;4. University of Wisconsin, Department of Surgery, 600 Highland Avenue, Madison, WI, USA;5. University of Massachusetts Medical School, Department of Surgery, 55 Lake Avenue, Worcester, MA, USA;1. Department of Neurosurgery, University Hospital Bonn, Bonn, Germany;2. Clinical Study Core Unit SZB and Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Germany;3. Clinical Study Core Unit SZB and Institute for Medical Biometry, Informatic and Epidemiology, University of Bonn, Germany;4. Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany;1. Hospital Universitario 12 de Octubre, Servicio de Radiología, Madrid, Spain;2. Servicio de Cuidados Intensivos y Grandes Quemados, CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Madrid, Spain;3. Centre Hospitalier Universitaire de Poitiers, Service de Médecine Intensive Réanimation CHU de Poitiers, ALIVE research group, INSERM CIC 1402, University of Poitiers, Poitiers, France;4. Servicio de Radiología, Unidad de tórax, Hospital Universitario de Getafe, Madrid, Spain;5. Hospital Ramón y Cajal, Unidad de Bioestadistica Clínica, Hospital Ramón y Cajal IRYCIS, CIBERESP, Departamento Enfermeria y Fisioterapia, Universidad de Alcalá, Madrid, Spain;6. Servicio de Anatomía Patológica, Hospital Universitario de Getafe, Madrid, Spain;7. Hospital Español Juan José Crottogini, Unidad de Cuidados Intensivos, Montevideo, Uruguay;1. UCLA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, USA;2. Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Australia;3. UCLA, Department of Medicine, David Geffen School of Medicine, USA;4. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, USA;5. UCLA, Department of Medicine, Quality Improvement, David Geffen School of Medicine, USA;6. UCLA, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, USA |
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| Abstract: | PurposeNew onset atrial fibrillation (NOAF) in critically ill patients has been associated with increased short-term mortality. Analyses that do not take into account the time-varying nature of NOAF can underestimate its association with hospital outcomes.We investigated the prognostic association of NOAF with hospital outcomes using competing risks methods.Materials and methodsWe undertook a retrospective cohort study in three general adult intensive care units (ICUs) in the UK from June 2008 to December 2015. We excluded patients with known prior atrial fibrillation or an arrhythmia within four hours of ICU admission.To account for the effect of NOAF on the rate of death per unit time and the rate of discharge alive per unit time we calculated subdistribution hazard ratios (SDHRs).ResultsOf 7541 patients that fulfilled our inclusion criteria, 831 (11.0%) developed NOAF during their ICU admission. NOAF was associated with an increased duration of hospital stay (CSHR 0.68 (95% CI 0.63–0.73)) and an increased rate of in-hospital death per unit time (CSHR 1.57 (95% CI 1.37–1.1.81)). This resulted in a strong prognostic association with dying in hospital (adjusted SDHR 2.04 (1.79–2.32)). NOAF lasting over 30 min was associated with increased hospital mortality.ConclusionsUsing robust methods we demonstrate a stronger prognostic association between NOAF and hospital outcomes than previously reported. |
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