G Hossein Almassi1, Robert B Hawkins2, Muath Bishawi3, A Laurie Shroyer4, Brack Hattler5, Jacquelyn A Quin6, Joseph F Collins7, Faisal G Bakaeen8, Ramin Ebrahimi9, Frederick L Grover5, Todd H Wagner10. 1. Cardiothoracic Surgery, Zablocki Veterans Affairs Medical Center, Milwaukee, Wis; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis. Electronic address: halmassi@mcw.edu. 2. Department of Surgery, Salem Veterans Affairs Medical Center, Salem, Va; Department of Surgery, University of Virginia, Charlottesville, Va. 3. Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Department of Surgery, Duke University Medical Center, Durham, NC. 4. Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo. 5. Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo; Departments of Surgery and Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colo. 6. Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass; Harvard Medical School, Boston, Mass. 7. Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, Md. 8. Department of Surgery, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, Pa; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 9. Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif; Department of Medicine, University of California Los Angeles, Los Angeles, Calif. 10. Health Economics Resource Center, Palo Alto Veterans Affairs Medical Center, Menlo Park, Calif; Department of Surgery, Stanford University, Stanford, Calif.
Abstract
OBJECTIVE: The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs "Randomized On/Off Bypass Follow-up Study" compared 5-year outcomes and costs between patients with and without POAF. METHODS: Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n = 551) and patients without POAF (n = 1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of ≤.01 was required to identify statistical significance. RESULTS: Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P = .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P = .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. CONCLUSIONS: No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years. Published by Elsevier Inc.
OBJECTIVE: The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs "Randomized On/Off Bypass Follow-up Study" compared 5-year outcomes and costs between patients with and without POAF. METHODS: Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n = 551) and patients without POAF (n = 1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of ≤.01 was required to identify statistical significance. RESULTS:Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P = .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P = .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. CONCLUSIONS: No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years. Published by Elsevier Inc.
Entities:
Keywords:
atrial fibrillation; costs and cost analysis; treatment outcome; veterans
Authors: Michael K Wang; Pascal B Meyre; Rachel Heo; P J Devereaux; Lauren Birchenough; Richard Whitlock; William F McIntyre; Yu Chiao Peter Chen; Muhammad Zain Ali; Fausto Biancari; Jawad Haider Butt; Jeff S Healey; Emilie P Belley-Côté; Andre Lamy; David Conen Journal: CJC Open Date: 2021-09-16