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Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis
Rachel Eikelboom1, Rohan Sanjanwala2, Me-Linh Le3
1Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
Insights
Postoperative atrial fibrillation (POAF) after cardiac surgery is linked to increased long-term death. Enhanced POAF prevention and management strategies, including diligent follow-up, are recommended to improve patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Public Health
Background:
- Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery.
- While POAF is known to increase in-hospital mortality and stroke, its long-term impact on patient survival is not fully understood.
Purpose of the Study:
- To systematically review and investigate the association between POAF and long-term death and stroke in adult patients undergoing cardiac operations.
Main Methods:
- A systematic literature review and meta-analysis of studies published from inception to October 2018.
- Included studies compared long-term outcomes in cardiac surgery patients with and without POAF.
- Risk of bias was assessed using the Newcastle-Ottawa Scale.
Main Results:
- The review included 32 studies with 155,575 patients; 23.7% experienced POAF.
- Meta-analysis of 10 studies showed a 2.60 odds ratio for 1-year death in patients with POAF.
- Aggregate analysis of 16 studies revealed an increased hazard ratio of 1.25 for long-term death in patients with POAF.
Conclusions:
- POAF following cardiac surgery is associated with an increased risk of long-term mortality.
- More robust strategies for POAF prevention, management, and post-discharge monitoring are warranted.
- Further research is needed to elucidate the mechanisms connecting POAF and mortality in this patient cohort.
Background:
Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with longer hospital stay and increased in-hospital death and stroke, but its long-term implications remain incompletely understood. A systematic literature review was undertaken to investigate the impact of POAF on long-term death and stroke in adult patients who undergo cardiac operations.
Methods:
Electronic databases (Cochrane, Embase, Ovid MEDLINE, and PubMed) were queried from inception to October 2018. Included studies compared long-term outcomes after cardiac operations in patients with and without POAF. Adjusted and unadjusted meta-analyses examined death, stroke, and major adverse cardiac and cerebrovascular events. Risk of bias was evaluated with the Newcastle-Ottawa Scale.
Results:
The inclusion criteria were met by 32 studies describing 155,575 patients who had undergone cardiac operations. POAF occurred in 36,988 patients (23.7%). Meta-analysis of 10 studies (44,367 patients) demonstrated increased 1-year death in patients with POAF (odds ratio, 2.60; 95% confidence interval, 2-3.38; P < .01). Aggregate adjusted hazard of death (16 studies, n = 84,295) was also increased in patients with POAF (hazard ratio, 1.25; 95% confidence interval, 1.2-1.3; P < .01).
Conclusions:
This systematic review and meta-analysis identified an association between POAF and long-term death after cardiac surgery. More comprehensive POAF prevention and management, including more stringent follow-up for POAF recurrence after hospital discharge, may be indicated. The included studies used inconsistent definitions of POAF and variable exclusion criteria; however, estimates of heterogeneity are low. Differences in preoperative comorbidities, such as age, ejection fraction, and obesity, may not be fully accounted for in adjusted analyses. Future work is required to delineate mechanisms linking POAF and death in this population.
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