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Published on: February 26, 2013
The Association Between Atrial Fibrillation Burden and All-Cause Mortality in Critically Ill Survivors: A
Shan-Lin Wen1, Wei Wang1, Ming-Wen Hu1
1Department of Cardiology, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Background:
Atrial fibrillation (AF) is a common condition among critically ill patients, and AF burden serves as a quantitative measure of its occurrence. However, no studies have investigated the impact of in-hospital AF burden on the prognosis of critically ill patients.
Aim:
To explore the impact of AF burden during intensive care unit (ICU) on all-cause mortality.
Study Design:
This retrospective observational study utilised population data from the Medical Information Mart for Intensive Care-IV Database. Patients who experienced episodes of AF during their ICU stay and were discharged from the hospital were included, and AF burden was calculated on the basis of nurse-documented hourly cardiac rhythm. We classified patients into three groups based on the tertile of AF burden: low (T1, < 9.58%), medium (T2, 9.58%-62.42%) and high (T3, ≥ 62.43%). The multivariate Cox regression models and restricted cubic spline analyses were used to estimate hazard ratios and 95% CIs and explore linear and nonlinear relationships of AF burden and all-cause mortality, respectively.
Results:
A total of 6215 critically ill survivors with the episode of AF during the ICU stay were included. The mean age was 72.46 ± 11.86 years. High AF burden was associated with an increased risk of 1-year all-cause mortality (adjusted hazard ratio: 1.28, 95% CI: 1.13-1.45, p < 0.001), and restricted cubic spline analyses showed a linear relationship of AF burden with 1-year all-cause mortality. Additionally, there were no significant associations of AF burden and 30-day all-cause mortality.
Conclusion:
In critically ill survivors, high AF burden during the ICU stay was associated with increased 1-year all-cause mortality, but not with 30-day all-cause mortality.
Relevance To Clinical Practice:
This finding underscores the value of nurse-documented AF burden in long-term risk stratification of discharged critically ill patients with AF, facilitating individual management to improve the prognosis.
