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Is atrial fibrillation a risk factor for in-hospital cardiac arrest?: a Swedish retrospective cohort study
Alexander Ryden1, Johan Engdahl2, Andreas Claesson3
1Function of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
Insights
Patients with atrial fibrillation (AF) face a higher risk of in-hospital cardiac arrest (IHCA). This study found AF is an independent risk factor for IHCA, highlighting the need for targeted interventions in these patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Epidemiology
Background:
- Atrial fibrillation (AF) is a known risk factor for morbidity and mortality.
- Previous research linked AF to out-of-hospital cardiac arrest.
- The association between AF and in-hospital cardiac arrest (IHCA) remains unclear.
Purpose of the Study:
- To investigate the association between AF and IHCA.
- To determine if AF is an independent risk factor for IHCA in hospitalized patients.
Main Methods:
- Retrospective cohort study of adult patients admitted to Karolinska University Hospital (2014-2015).
- Patients were categorized into AF and non-AF groups based on ICD-10 code I48.
- IHCA occurrence was the primary outcome, analyzed using multivariable logistic regression.
Main Results:
- 102,416 patients included; 10% had AF.
- 326 patients ( <1%) experienced IHCA.
- AF was significantly associated with IHCA (OR 1.760; 95% CI 1.356 to 2.269; p<0.001) after adjusting for confounders.
Conclusions:
- Hospitalized patients with AF demonstrated a stronger association with IHCA compared to those without AF.
- Atrial fibrillation may be an independent risk factor for in-hospital cardiac arrest.
- Findings suggest a need for increased vigilance and potential preventative strategies for AF patients at risk of IHCA.
Introduction:
Atrial fibrillation (AF) is associated with increased morbidity and mortality. Recent findings suggest that AF is also associated with out-of-hospital cardiac arrest. However, whether that association can be generalised to in-hospital cardiac arrests (IHCAs) is still unknown.
Aims:
To examine whether there is a stronger association with IHCA among hospitalised patients with AF compared with patients without AF.
Materials And Methods:
All adult patients admitted to the Karolinska University Hospital, Stockholm, Sweden during 2014-2015 were included. Data were drawn from their medical file and matched against the Swedish Registry for Cardiopulmonary Resuscitation. Patients who were documented as ever having the International Classification of Diseases, 10th revision code I48 prior to the current hospitalisation were categorised to the AF group and the remaining were categorised to the non-AF group. The primary outcome was occurrence of an IHCA.
Results:
In all, 102 416 patients were included. Among these, 10% had been diagnosed with AF and <1% (n=326) suffered from an IHCA, only 42 (13%) had a VF/VT. In a multivariable model adjusting for sex, age, CharlsonComorbidity Index score and whether the patients had been admitted electively or urgently, having AF was significantly associated with IHCA (OR 1.760; 95% CI 1.356 to 2.269; p<0.001).
Conclusions:
Within this observational cohort study, patients with AF had a stronger association with IHCA than patients without AF. AF might be an independent risk factor for IHCA.
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