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Published on: February 26, 2013
New-onset postoperative atrial fibrillation management and outcomes: the VISION Cardiac Surgery cohort
William F McIntyre1,2,3, P J Devereaux1,2,3, Emilie P Belley-Cote1,2,3
1Population Health Research Institute, 237 Barton St E, L8L 2X2, Hamilton, Ontario, Canada.
Insights
Postoperative atrial fibrillation (POAF) affects nearly a third of cardiac surgery patients, increasing their risk of death within a year. Management of POAF varies, highlighting the need for standardized care protocols.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery.
- Existing data on POAF incidence, management, and long-term outcomes are limited, primarily from registries and single-center studies.
Purpose of the Study:
- To determine the incidence of POAF in a large, multi-center prospective cohort.
- To describe the management strategies employed for POAF.
- To investigate the association between POAF and long-term outcomes up to one year post-surgery.
Main Methods:
- Prospective cohort study (VISION Cardiac Surgery) involving 12,234 adult patients across 12 countries.
- Analysis of POAF incidence within 30 days of surgery.
- Multivariable Cox regression models were used to assess the association of POAF with outcomes at 30 days to 1 year, adjusting for covariates.
Main Results:
- The incidence of POAF was 31.8% within 30 days of cardiac surgery.
- Management at discharge varied significantly, with 15.6% receiving anticoagulation alone, 54.3% antiplatelets alone, and 48.8% amiodarone.
- At one year, patients with POAF had a significantly higher risk of clinical AF (aHR 11.30) and all-cause death (aHR 1.54) compared to those without POAF.
Conclusions:
- New-onset POAF affects approximately one-third of patients undergoing cardiac surgery.
- There is considerable variability in the antithrombotic and antiarrhythmic management of POAF.
- POAF is associated with increased risks of recurrent AF and all-cause mortality in the year following surgery.
Background And Aims:
New-onset atrial fibrillation (AF) is the most common complication of cardiac surgery. We aimed to describe the incidence of postoperative AF (POAF), its management, and its relationship to long-term outcomes in a prospective multi-centre cohort, as our current understanding comes primarily from registries and single-centre studies.
Methods:
VISION Cardiac Surgery was a prospective cohort of adults who underwent cardiac surgery in 12 countries. The association of POAF with outcomes occurring between 30 days and 1 year postoperatively was estimated using a multivariable Cox model adjusted for patient and operative characteristics and for antithrombotic therapies.
Results:
Among 12 234 patients (55.3% isolated coronary artery bypass grafting), 31.8% had POAF within 30 days of surgery. The proportion of participants with POAF who received anticoagulation alone at hospital discharge was 15.6%, 54.3% received antiplatelets alone, 23.9% received anticoagulation and antiplatelets, and 6.3% received neither; 48.8% were receiving amiodarone. At 1 year, clinical AF was detected in 6.9% of patients with POAF compared to 0.6% in those without [adjusted hazard ratio (aHR), 11.30; 95% confidence interval (CI) 8.17-15.70]. The primary composite outcome of stroke or vascular death occurred in 2.3% of patients with POAF and 1.5% in those without POAF (aHR 1.32; 95% CI 0.99-1.77). Patients with POAF had a higher risk of all-cause death (3.0% vs 1.7%; aHR 1.54; 95% CI 1.18-2.00).
Conclusions:
New-onset POAF occurs in a third of patients after cardiac surgery; its antithrombotic and antiarrhythmic management varies. Patients with POAF have increased risks of both clinical AF and of all-cause death in the year following surgery.
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