Prognosis and management of new‐onset atrial fibrillation in critically ill patients

Abstract

Abstract Introduction The prognosis of new-onset atrial fibrillation (AF) compared with that of preexisting and non-AF remains controversial. The purpose of this study was to evaluate the effect of new-onset AF compared with preexisting and non-AF on hospital and 90-day mortality. Methods A retrospective cohort study was performed using data obtained from the Medical Information Mart for Intensive Care III database. The primary outcome was 90-day mortality. Secondary outcomes included hospital mortality, hospital and intensive care unit (ICU) length of stay, and acute kidney injury. Logistic and Cox regression analyses were performed to evaluate the relationship between new-onset AF and study outcomes. Results A total of 38,159 adult patients were included in the study. The incidence of new-onset AF was 9.4%. Ninety-day mortality, hospital mortality, and hospital and ICU length of stay in patients with new-onset and preexisting AF were significantly increased compared with those in patients with non-AF patients (all p < 0.001). After adjusting for patient characteristics, new-onset AF remained associated with increased 90-day mortality compared with non-AF (adjusted hazard ratio (HR) 1.37, 95% confidence interval (CI) 1.26 to 1.50; p < 0.01) and preexisting AF (adjusted HR 1.12; 95%-CI 1.02 to 1.23; p < 0.01). Patients in the surgical intensive care unit (SICU) had significantly higher 90-day mortality than patients in the coronary care unit (adjusted HR 1.30; 95% CI 1.31 to 1.51; p < 0.001). Conclusions Critically ill patients with new-onset AF have significantly increased hospital and 90-day mortality compared with patients with preexisting and non-AF. Patients with new-onset AF in the ICU, especially those in the SICU, require robust management measures.