Atrial fibrillation (AFIB) in the ICU : incidence, risk factors, and outcomes : the international AFIB-ICU cohort study
Wetterslev, Mik; Hylander Møller, Morten; Granholm, Anders; Hassager, Christian; Haase, Nicolai; Lange, Theis; Myatra, Sheila N.; Hästbacka, Johanna; Arabi, Yaseen M.; Shen, Jiawei; Cronhjort, Maria; Lindqvist, Elin; Aneman, Anders; Young, Paul J.; Szczeklik, Wojciech; Siegemund, Martin; Koster, Thijs; Aslam, Tayyba Naz; Bestle, Morten H.; Girkov, Mia S.; Kalvit, Kushal; Mohanty, Rakesh; Mascarenhas, Joanne; Pattnaik, Manoranjan; Vergis, Sara; Haranath, Sai Praveen; Shah, Mehul; Joshi, Ziyokov; Wilkman, Erika; Reinikainen, Matti; Lehto, Pasi; Jalkanen, Ville; Pulkkinen, Anni; An, Youzhong; Wang, Guoxing; Huang, Lei; Huang, Bin; Liu, Wei; Gao, Hengbo; Dou, Lin; Li, Shuangling; Yang, Wanchun; Tegnell, Emily; Knight, Agnes; Czuczwar, Miroslaw; Czarnik, Tomasz; Perner, Anders; the AFIB-ICU Collaborators (2023-04-20)
Wetterslev, Mik MD, PhD1; Hylander Møller, Morten MD, PhD1; Granholm, Anders MD1; Hassager, Christian MD, MedScD2; Haase, Nicolai MD, PhD1; Lange, Theis MSc, PhD3; Myatra, Sheila N. MD4; Hästbacka, Johanna MD, PhD5; Arabi, Yaseen M. MD6; Shen, Jiawei MD7; Cronhjort, Maria MD, PhD8; Lindqvist, Elin MD8; Aneman, Anders MD, PhD9,10; Young, Paul J. MD, PhD11,12; Szczeklik, Wojciech MD, PhD13; Siegemund, Martin MD14; Koster, Thijs MD15; Aslam, Tayyba Naz MD16; Bestle, Morten H. MD, PhD17,18; Girkov, Mia S. MD19; Kalvit, Kushal MD4; Mohanty, Rakesh MD4; Mascarenhas, Joanne MD20; Pattnaik, Manoranjan MD21; Vergis, Sara MD22; Haranath, Sai Praveen MD23; Shah, Mehul MD24; Joshi, Ziyokov MD25; Wilkman, Erika MD, PhD5; Reinikainen, Matti MD, PhD26; Lehto, Pasi MD27; Jalkanen, Ville MD, PhD28; Pulkkinen, Anni MD29; An, Youzhong MD7; Wang, Guoxing MD30; Huang, Lei MD31; Huang, Bin MD32; Liu, Wei MD33; Gao, Hengbo MD34; Dou, Lin MD35; Li, Shuangling MD36; Yang, Wanchun MD37; Tegnell, Emily MD38; Knight, Agnes MD39; Czuczwar, Miroslaw MD, PhD40; Czarnik, Tomasz MD, PhD41; Perner, Anders MD, PhD1; the AFIB-ICU Collaborators. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study*. Critical Care Medicine 51(9):p 1124-1137, September 2023. | DOI: 10.1097/CCM.0000000000005883
© 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is a non-final version of an article published in final form in Wetterslev, Mik MD, PhD1; Hylander Møller, Morten MD, PhD1; Granholm, Anders MD1; Hassager, Christian MD, MedScD2; Haase, Nicolai MD, PhD1; Lange, Theis MSc, PhD3; Myatra, Sheila N. MD4; Hästbacka, Johanna MD, PhD5; Arabi, Yaseen M. MD6; Shen, Jiawei MD7; Cronhjort, Maria MD, PhD8; Lindqvist, Elin MD8; Aneman, Anders MD, PhD9,10; Young, Paul J. MD, PhD11,12; Szczeklik, Wojciech MD, PhD13; Siegemund, Martin MD14; Koster, Thijs MD15; Aslam, Tayyba Naz MD16; Bestle, Morten H. MD, PhD17,18; Girkov, Mia S. MD19; Kalvit, Kushal MD4; Mohanty, Rakesh MD4; Mascarenhas, Joanne MD20; Pattnaik, Manoranjan MD21; Vergis, Sara MD22; Haranath, Sai Praveen MD23; Shah, Mehul MD24; Joshi, Ziyokov MD25; Wilkman, Erika MD, PhD5; Reinikainen, Matti MD, PhD26; Lehto, Pasi MD27; Jalkanen, Ville MD, PhD28; Pulkkinen, Anni MD29; An, Youzhong MD7; Wang, Guoxing MD30; Huang, Lei MD31; Huang, Bin MD32; Liu, Wei MD33; Gao, Hengbo MD34; Dou, Lin MD35; Li, Shuangling MD36; Yang, Wanchun MD37; Tegnell, Emily MD38; Knight, Agnes MD39; Czuczwar, Miroslaw MD, PhD40; Czarnik, Tomasz MD, PhD41; Perner, Anders MD, PhD1; the AFIB-ICU Collaborators. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study*. Critical Care Medicine 51(9):p 1124-1137, September 2023. | DOI: 10.1097/CCM.0000000000005883.
https://rightsstatements.org/vocab/InC/1.0/
https://urn.fi/URN:NBN:fi-fe20230901115135
Tiivistelmä
Abstract
Objectives: To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF.
Design: Multicenter, prospective, inception cohort study.
Setting: Forty-four ICUs in 12 countries in four geographical regions.
Subjects: Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021.
Intervention: None.
Measurements and main results: We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8–17.6), of which newly developed AF was 13.3% (11.5–15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16–23), magnesium 16% (13–20), potassium 15% (12–19), amiodarone 51% (47–55),beta-1 selective blockers 34% (30–38), calcium channel blockers 4% (2–6), digoxin 16% (12–19), and direct current cardioversion in 4% (2–6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95–1.99).
Conclusions: In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.
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