Advertisement

Risk of incident atrial fibrillation after a prior critical illness: A retrospective cohort study

  • Wei-Syun Hu
    Correspondence
    Corresponding author at: Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung 40447, Taiwan.
    Affiliations
    School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan

    Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan
    Search for articles by this author
  • Cheng-Li Lin
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan
    Search for articles by this author
Published:September 19, 2018DOI:https://doi.org/10.1016/j.ejim.2018.09.001

      Highlights

      • This is a nationwide cohort study.
      • Propensity matching and competing risk methods were used.
      • Risk of AF after a prior diagnosis of critical condition was noted.

      Abstract

      Objective

      This investigation aimed at assessing the issue of incident atrial fibrillation (AF) associated with acute critical illness.

      Methods

      The study came from Taiwan and used that nation's Longitudinal Health Insurance Database 2000. Using propensity score matching, multivariable adjustment and competing risk methods, the correlations between the new-onset AF and critical illness (septicemia/septic shock, acute myocardial infarction【AMI】, hemorrhagic stroke and ischemic stroke) were investigated.

      Results

      This study consisted of 46470 patients in the critical illness cohort, 618998 persons in the general population cohort. Additionally, 37,060 critically ill patients were matched with 37060 control patients based on propensity score methods. Compared with general population cohort, patients with septicemia/septic shock were 3.12-fold more likely to develop AF (95% confidence interval 【CI】 = 2.88–3.39), followed by patients with ischemic stroke (adjusted hazard ratio【aHR】 = 1.96, 95% CI = 1.80–2.14), patients with AMI (aHR = 1.62, 95% CI = 1.32–2.00) and patients with hemorrhagic stroke (aHR = 1.46, 95% CI = 1.13–1.88). In addition, after controlling for the confounding factors and the competing risk of death, the critical illness cohort still exhibited a significantly higher risk of AF than the general population cohort (adjusted subhazard ratio [aSHR] = 2.66, 95% CI = 2.49–2.84).

      Conclusions

      Our study explored incident AF among patients with critical illness in their medical history. Patients with septicemia/septic shock were at the highest risk of developing new-onset AF among these critically ill patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • Calkins H.
        • Cigarroa J.E.
        • Cleveland Jr., J.C.
        Et al; American College of Cardiology/American Heart Association Task Force on Practice guidelines. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2014 Dec 2; 64: e1-76
        • Camm A.J.
        • Lip G.Y.
        • De Caterina R.
        • Savelieva I.
        • Atar D.
        • Hohnloser S.H.
        Et al; ESC Committee for Practice guidelines (CPG). 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association.
        Eur Heart J. 2012 Nov; 33: 2719-2747
        • Page R.L.
        Clinical practice. Newly diagnosed atrial fibrillation.
        N Engl J Med. 2004 Dec 2; 351: 2408-2416
        • Stewart S.
        • Hart C.L.
        • Hole D.J.
        • McMurray J.J.
        A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study.
        Am J Med. 2002 Oct 1; 113: 359-364
        • Chean C.S.
        • McAuley D.
        • Gordon A.
        • Welters I.D.
        Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey.
        Peer J. 2017 Sep 8; 5e3716
        • Carrera P.
        • Thongprayoon C.
        • Cheungpasitporn W.
        • Iyer V.N.
        • Moua T.
        Epidemiology and outcome of new-onset atrial fibrillation in the medical intensive care unit.
        J Crit Care. 2016 Dec; 36: 102-106
        • Lewis O.
        • Ngwa J.
        • Gillum R.F.
        • Thomas A.
        • Davis W.
        • Poddar V.
        • et al.
        Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American patients with Severe Sepsis.
        Ethn Dis. 2016 Apr 21; 26: 205-212
        • Koyfman L.
        • Brotfain E.
        • Kutz R.
        • Frenkel A.
        • Schwartz A.
        • Boniel A.
        • et al.
        Epidemiology of new-onset paroxysmal atrial fibrillation in the General Intensive Care Unit population and after discharge from ICU. A retrospective epidemiological study.
        Anaesthesiol Intensive Ther. 2015; 47: 309-314
        • Shaver C.M.
        • Chen W.
        • Janz D.R.
        • May A.K.
        • Darbar D.
        • Bernard G.R.
        • et al.
        Atrial Fibrillation is an Independent Predictor of Mortality in Critically Ill patients.
        Crit Care Med. 2015 Oct; 43: 2104-2111
        • Walkey A.J.
        • Hogarth D.K.
        • Lip G.Y.H.
        Optimizing atrial fibrillation management: from ICU and beyond.
        Chest. 2015 Oct; 148: 859-864
        • Yoshida T.
        • Fujii T.
        • Uchino S.
        • Takinami M.
        Epidemiology, prevention, and treatment of new-onset atrial fibrillation in critically ill: a systematic review.
        J Intensive Care. 2015 Apr 23; 3: 19
        • Chen A.Y.
        • Sokol S.S.
        • Kress J.P.
        • Lat I.
        New-onset atrial fibrillation is an independent predictor of mortality in medical intensive care unit patients.
        Ann Pharmacother. 2015 May; 49: 523-527
        • Database NHIR. Taiwan
        http://nhird.nhri.org.tw/en/index.html
        Date accessed: May 10, 2017
        • Hu W.S.
        • Lin C.L.
        Association between Cataract and risk of Incident Atrial Fibrillation: a Nationwide Population-based Retrospective Cohort Study.
        Mayo Clin Proc. 2017 Mar; 92: 370-375
        • Hu W.S.
        • Lin C.L.
        • Chang S.S.
        • Chen M.F.
        • Chang K.C.
        Increased risk of ischemic heart disease among subjects with cataracts: a population-based cohort study.
        Medicine (Baltimore). 2016 Jul; 95e4119
      1. Parsons LS. Performing a 1:N case-control match on propensity score. In: Proceedings of the 29th Annual SAS Users Group International Conference; May 9-12, 2004; [Montreal, Canada].

        • Austin P.C.
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009 Nov 10; 28: 3083-3107
        • Fine J.P.
        • Gray R.J.
        A Proportional Hazards Model for the Subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
        • Ogawa S.
        • Aonuma K.
        • Tse H.F.
        • Huang D.
        • Huang J.L.
        • Kalman J.
        • et al.
        TheAPHRS's 2013 statement on antithrombotic therapy of patients with nonvalvular atrial fibrillation.
        J Arrhythm. 2013; 29: 190-200
        • Lip G.Y.
        • Nieuwlaat R.
        • Pisters R.
        • Lane D.A.
        • Crijns H.J.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
        Chest. 2010 Feb; 137: 263-272
        • Fuster V.
        • Rydén L.E.
        • Cannom D.S.
        • Crijns H.J.
        • Curtis A.B.
        • Ellenbogen K.A.
        • et al.
        2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
        Am Coll Cardiol. 2011 Mar 15; 57: e98-101
        • Gage B.F.
        • Waterman A.D.
        • Shannon W.
        • Boechler M.
        • Rich M.W.
        • Radford M.J.
        Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.
        JAMA. 2001 Jun 13; 285: 2864-2870