New-Onset Atrial Fibrillation in the Critically Ill

Area of Science:

• Critical Care Medicine
• Cardiology
• Health Informatics

Background:

• Atrial fibrillation (AF) is a common arrhythmia.
• Early detection and understanding of AF in intensive care unit (ICU) patients are crucial for improving outcomes.
• Continuous electrocardiogram (ECG) monitoring offers potential for identifying new-onset AF.

Purpose of the Study:

• To determine the association of new-onset atrial fibrillation (NOAF) with ICU length of stay and survival.
• To identify predictors of NOAF in critically ill patients.
• To evaluate the impact of NOAF on hospital and post-discharge outcomes.

Main Methods:

• Retrospective cohort study of 8,356 adult ICU admissions with continuous ECG data.
• NOAF was detected using automated analysis (≥ 90 seconds in 30 minutes) and defined as no prior AF diagnosis.
• Propensity matching was used to assess the impact of NOAF on outcomes.

Main Results:

• Atrial fibrillation was detected in 19% of admissions, with NOAF occurring in 8% of all ICU admissions.
• Advanced age, acute respiratory failure, and sepsis were key predictors of NOAF.
• Clinical NOAF was associated with increased hospital mortality (OR 1.63) and longer ICU length of stay (2.25 days).

Conclusions:

• Automated ECG analysis effectively detects NOAF in ICU patients, often revealing transient or unrecognized episodes.
• NOAF, even when subclinical, is associated with adverse hospital outcomes, including higher mortality and prolonged ICU stays.
• NOAF did not show an association with survival after hospital discharge.