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Published on: February 26, 2013
The long-term impact of postoperative atrial fibrillation after cardiac surgery
Valentino Bianco1, Arman Kilic1, Sarah Yousef2
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Insights
New-onset postoperative atrial fibrillation after cardiac surgery is linked to increased long-term mortality and hospital readmissions, particularly for heart failure. This highlights the importance of managing atrial fibrillation post-surgery for better patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes
Background:
- Atrial fibrillation is a known complication following cardiac surgery.
- Existing literature suggests worse in-hospital outcomes for patients with atrial fibrillation.
Purpose of the Study:
- To investigate the long-term impact of new-onset postoperative atrial fibrillation (POAF) on survival and hospital readmission rates.
- To analyze the association between POAF and long-term clinical outcomes in cardiac surgery patients.
Main Methods:
- Retrospective review of open cardiac surgery patients, excluding specific procedures and preoperative atrial fibrillation.
- 1:1 propensity matching to create comparable cohorts of patients with and without POAF.
- Multivariable analysis to identify independent predictors of mortality and readmission.
Main Results:
- New-onset POAF occurred in 35.2% of patients.
- No significant difference in operative mortality or stroke between groups.
- POAF patients showed higher rates of reoperation, transfusion, sepsis, prolonged ventilation, pneumonia, renal failure, and dialysis.
- POAF was independently associated with increased long-term mortality (HR 1.21), all-cause readmissions (HR 1.05), and heart failure readmissions (HR 1.14).
Conclusions:
- Patients experiencing new-onset POAF face significantly worse perioperative morbidity.
- Postoperative atrial fibrillation is linked to reduced long-term survival rates.
- Higher rates of hospital readmissions, especially for heart failure, are observed in the POAF cohort.
Objective:
The literature has reported worse in-hospital outcomes for patients with atrial fibrillation. The objective of the following study is to provide detailed results on the long-term impact of postoperative atrial fibrillation on survival and hospital readmission in cardiac surgery.
Methods:
All patients undergoing open cardiac surgery were reviewed with the exclusion of preoperative atrial fibrillation or patients undergoing ventricular assist device, transplant, or Cox-Maze procedures. Propensity matching (1:1) was performed to ensure similar baseline characteristics. Multivariable analysis identified significant associations with mortality and readmission.
Results:
A total of 12,227 patients with cardiac disease were divided into 7927 patients (64.8%) without postoperative atrial fibrillation and 4300 patients (35.2%) with new-onset postoperative atrial fibrillation. Propensity matching (1:1) yielded 4275 risk-adjusted pairs. There was no difference between the nonpostoperative atrial fibrillation versus postoperative atrial fibrillation cohorts regarding operative mortality (4.61% vs 4.12%; P = .26) and stroke (2.32% vs 2.76%; P = .191). Patients with postoperative atrial fibrillation had higher rates of reoperation (12.12% vs 6.83%; P < .001), transfusion (43.42% vs 36.94%; P < .001), sepsis (1.99% vs 0.80%; P < .001), prolonged ventilation (15.88% vs 9.24% vs; P < .001), pneumonia (6.60% vs 2.36%; P < .001), renal failure (6.90% vs 3.37%; P < .001), and dialysis (4.94% vs 2.08%; P < .001). The postoperative atrial fibrillation cohort had a significantly higher incidence of atrial fibrillation on follow-up (11.74% vs 4.75%; P < .001). Postoperative atrial fibrillation was independently associated with mortality (hazard ratio, 1.21; 1.12-1.33; P < .001), all-cause readmissions (hazard ratio, 1.05; 1.01-1.1; P = .010), and heart failure-specific readmission (hazard ratio, 1.14; 1.04-1.26; P = .01).
Conclusions:
Patients in the postoperative atrial fibrillation cohort had worse perioperative morbidity, lower survival, and more readmissions for heart failure on long-term follow-up.
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