Jonathan P Bedford1, Stephen Gerry2, Robert A Hatch3, Ian Rechner4, J Duncan Young5, Peter J Watkinson6. 1. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. Electronic address: JonathanBedford@ndcn.ox.ac.uk. 2. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK. Electronic address: Stephen.Gerry@csm.ox.ac.uk. 3. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. Electronic address: Robert.Hatch@ndcn.ox.ac.uk. 4. Department of Intensive Care Medicine, Royal Berkshire Hospital, Reading, UK. Electronic address: Ian.Rechner@royalberkshire.nhs.uk. 5. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. Electronic address: Duncan.Young@ndcn.ox.ac.uk. 6. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. Electronic address: Peter.Watkinson@ndcn.ox.ac.uk.
Abstract
PURPOSE: New onset atrial fibrillation (NOAF) in critically ill patients has been associated with increased short-term mortality. Analyses that do not take into account the time-varying nature of NOAF can underestimate its association with hospital outcomes. We investigated the prognostic association of NOAF with hospital outcomes using competing risks methods. MATERIALS AND METHODS: We undertook a retrospective cohort study in three general adult intensive care units (ICUs) in the UK from June 2008 to December 2015. We excluded patients with known prior atrial fibrillation or an arrhythmia within four hours of ICU admission. To account for the effect of NOAF on the rate of death per unit time and the rate of discharge alive per unit time we calculated subdistribution hazard ratios (SDHRs). RESULTS: Of 7541 patients that fulfilled our inclusion criteria, 831 (11.0%) developed NOAF during their ICU admission. NOAF was associated with an increased duration of hospital stay (CSHR 0.68 (95% CI 0.63-0.73)) and an increased rate of in-hospital death per unit time (CSHR 1.57 (95% CI 1.37-1.1.81)). This resulted in a strong prognostic association with dying in hospital (adjusted SDHR 2.04 (1.79-2.32)). NOAF lasting over 30 min was associated with increased hospital mortality. CONCLUSIONS: Using robust methods we demonstrate a stronger prognostic association between NOAF and hospital outcomes than previously reported.
PURPOSE: New onset atrial fibrillation (NOAF) in critically illpatients has been associated with increased short-term mortality. Analyses that do not take into account the time-varying nature of NOAF can underestimate its association with hospital outcomes. We investigated the prognostic association of NOAF with hospital outcomes using competing risks methods. MATERIALS AND METHODS: We undertook a retrospective cohort study in three general adult intensive care units (ICUs) in the UK from June 2008 to December 2015. We excluded patients with known prior atrial fibrillation or an arrhythmia within four hours of ICU admission. To account for the effect of NOAF on the rate of death per unit time and the rate of discharge alive per unit time we calculated subdistribution hazard ratios (SDHRs). RESULTS: Of 7541 patients that fulfilled our inclusion criteria, 831 (11.0%) developed NOAF during their ICU admission. NOAF was associated with an increased duration of hospital stay (CSHR 0.68 (95% CI 0.63-0.73)) and an increased rate of in-hospital death per unit time (CSHR 1.57 (95% CI 1.37-1.1.81)). This resulted in a strong prognostic association with dying in hospital (adjusted SDHR 2.04 (1.79-2.32)). NOAF lasting over 30 min was associated with increased hospital mortality. CONCLUSIONS: Using robust methods we demonstrate a stronger prognostic association between NOAF and hospital outcomes than previously reported.
Authors: Jonathan P Bedford; Alistair Johnson; Oliver Redfern; Stephen Gerry; James Doidge; David Harrison; Kim Rajappan; Kathryn Rowan; J Duncan Young; Paul Mouncey; Peter J Watkinson Journal: J Crit Care Date: 2021-11-16 Impact factor: 3.425
Authors: Jonathan P Bedford; Paloma Ferrando-Vivas; Oliver Redfern; Kim Rajappan; David A Harrison; Peter J Watkinson; James C Doidge Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-08-09