TY - JOUR

T1 - New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults

T2 - a multicenter retrospective cohort study

AU - Fernando, Shannon M

AU - Mathew, Rebecca

AU - Hibbert, Benjamin

AU - Rochwerg, Bram

AU - Munshi, Laveena

AU - Walkey, Allan J

AU - Møller, Morten Hylander

AU - Simard, Trevor

AU - Di Santo, Pietro

AU - Ramirez, F Daniel

AU - Tanuseputro, Peter

AU - Kyeremanteng, Kwadwo

PY - 2020

Y1 - 2020

N2 - BACKGROUND: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs.METHODS: Retrospective analysis (2011-2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost.RESULTS: We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97-1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09-1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02-1.20]). Among patients with NOAF, treatment with a rhythm-control strategy was associated with higher costs (CR 1.24 [95% CI 1.07-1.40]).CONCLUSIONS: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.

AB - BACKGROUND: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs.METHODS: Retrospective analysis (2011-2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost.RESULTS: We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97-1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09-1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02-1.20]). Among patients with NOAF, treatment with a rhythm-control strategy was associated with higher costs (CR 1.24 [95% CI 1.07-1.40]).CONCLUSIONS: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.

KW - Aged

KW - Aged, 80 and over

KW - Atrial Fibrillation/complications

KW - Cohort Studies

KW - Critical Illness/epidemiology

KW - Female

KW - Humans

KW - Intensive Care Units/organization & administration

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Ontario

KW - Outcome Assessment, Health Care/statistics & numerical data

KW - Registries/statistics & numerical data

KW - Retrospective Studies

KW - Risk Factors

KW - Statistics, Nonparametric

KW - Time Factors

U2 - 10.1186/s13054-020-2730-0

DO - 10.1186/s13054-020-2730-0

M3 - Journal article

C2 - 31931845

VL - 24

JO - Critical Care

JF - Critical Care

SN - 1364-8535

M1 - 15

ER -