Abstract
Background
New-onset atrial fibrillation (AF) in non-cardiac postoperative setting is common
and is associated with a high risk of in-hospital mortality and morbidity. The long-term
risks of stroke, mortality and AF recurrence rate in patients with postoperative AF
(POAF) are unclear.
Methods
We performed a systematic literature review in electronic databases from inception
to March 5th, 2020 of studies reporting the incidence of stroke, mortality and AF
recurrence in patients with POAF. We confined our analysis to studies with a cohort
of at least 150 patients with POAF and with a median follow-up of 12 months as a minimum.
Odds Ratios (OR) were pooled using a random-effects model.
Results
Qualitative analysis included 8 studies (7 observational cohort studies and 1 randomized
controlled trial) enrolling 3,718,587 patients. Six studies underwent metanalysis
comprising 17,684 postoperative patients with POAF and 2,169,248 postoperative patients
without POAF. The development of POAF conferred a four-fold increased risk of stroke
in the long-term [OR 4.05; 95% confidence interval (CI) 2.91–5.62]. Mortality in the
two studies reporting long-term data was higher in patients with POAF compared to
those without POAF (OR 3.59; CI 95% 2.84–4.53). Data about recurrence were too heterogeneous
to undergo metanalysis.
Conclusions
POAF is associated with a greater risk of stroke and mortality over the long-term
period. Studies focusing on AF recurrence are needed to address the perception of
POAF as a benign transient entity. The increased mortality risk following POAF should
encourage systematic detection and prevention of this arrhythmia.
Keywords
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Article info
Publication history
Published online: January 02, 2021
Accepted:
December 24,
2020
Received in revised form:
December 8,
2020
Received:
October 10,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
