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Published on: February 26, 2013
Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients
Ciara M Shaver1, Wei Chen, David R Janz
11Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 2Division of Pulmonary and Critical Care Medicine, Chiayi Christian Hospital, Chiayi, Taiwan. 3Section of Pulmonary and Critical Care Medicine, Louisiana State University School of Medicine New Orleans, LA. 4Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN. 5Division of Cardiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 6Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN.
Insights
Atrial fibrillation in the ICU independently increases the risk of death for critically ill patients. This risk is higher for those without sepsis, regardless of whether the condition is new-onset or recurrent.
Area of Science:
- Critical Care Medicine
- Cardiology
- Epidemiology
Background:
- Atrial fibrillation is linked to higher mortality in critically ill patients.
- The independent prognostic value of atrial fibrillation in the ICU requires further investigation.
- Distinguishing outcomes between new-onset and recurrent atrial fibrillation in critically ill patients is important.
Purpose of the Study:
- To determine if atrial fibrillation in the ICU is an independent risk factor for death.
- To compare risk factors and outcomes for new-onset versus recurrent atrial fibrillation in critically ill patients.
Main Methods:
- Prospective observational cohort study of 1770 critically ill patients.
- Data collected on demographics, medical history, atrial fibrillation development, and outcomes during the first 4 ICU days.
- Multivariable analysis used to control for illness severity and confounders.
Main Results:
- Atrial fibrillation (Any AF) occurred in 13% of patients; 7% had new-onset AF, 6% had recurrent AF.
- Any AF was independently associated with increased hospital mortality (OR, 1.62; P = 0.007).
- The association between AF and death was stronger in patients without sepsis (OR, 2.92; P = 0.001). New-onset AF was linked to diastolic dysfunction and vasopressor use.
Conclusions:
- Atrial fibrillation in critical illness, both new-onset and recurrent, is an independent predictor of increased hospital mortality.
- The increased mortality risk associated with atrial fibrillation is particularly pronounced in critically ill patients without sepsis.
- Treatment for atrial fibrillation did not impact hospital mortality in this cohort.
Objectives:
Atrial fibrillation has been associated with increased mortality in critically ill patients. We sought to determine whether atrial fibrillation in the ICU is an independent risk factor for death. A secondary objective was to determine if patients with new-onset atrial fibrillation have different risk factors or outcomes compared with patients with a previous history of atrial fibrillation.
Design:
Prospective observational cohort study.
Setting:
Medical and general surgical ICUs in a tertiary academic medical center.
Patients:
One thousand seven hundred seventy critically ill patients requiring at least 2 days in the ICU.
Interventions:
None.
Measurements And Main Results:
Demographics, medical history, development of atrial fibrillation, fluid balance, echocardiographic findings, medication administration, and hospital mortality were collected during the first 4 days of ICU admission. Atrial fibrillation occurred in 236 patients (13%) (Any AF). Of these, 123 patients (7%) had no prior atrial fibrillation (New-onset AF) while the remaining 113 (6%) had recurrent atrial fibrillation (Recurrent AF). Any AF was associated with male gender, Caucasian race, increased age, cardiac disease, organ failures, and disease severity. Patients with Any AF had increased mortality compared with those without atrial fibrillation (31% vs 17%; p < 0.001), and Any AF was independently associated with death (odds ratio, 1.62; 95% CI, 1.14-2.29; p = 0.007) in multivariable analysis controlling for severity of illness and other confounders. The association of atrial fibrillation with death was magnified in patients without sepsis (odds ratio, 2.92; 95% CI, 1.52-5.60; p = 0.001). Treatment for atrial fibrillation had no effect on hospital mortality. New-onset AF and Recurrent AF were each associated with increased mortality. New-onset AF, but not Recurrent AF, was associated with increased diastolic dysfunction and vasopressor use and a greater cumulative positive fluid balance.
Conclusions:
Atrial fibrillation in critical illness, whether new-onset or recurrent, is independently associated with increased hospital mortality, especially in patients without sepsis.
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