Afib Diagnosed During Critical Care Linked to Higher Long-Term Stroke Risk

An increased risk for stroke and systemic embolism (SE) was found among patients with newly diagnosed atrial fibrillation (AFib or AF) while receiving critical care compared with those without AF, according to a study recently published in Chest.

This study included 30,869 adults who had survived at least 6 months after being newly diagnosed with AF during critical care, as well as 269,751 controls with AF not diagnosed in critical care and 439,868 controls with no AF.

Data were sourced from the Korean National Health Insurance Service database from 2005 to 2013. Data on comorbidities were also collected. The primary outcome was first occurrence of all-cause mortality or stroke/SE. Propensity score matching was performed in a 1:1:1 ratio.

Poisson distribution was used to examine incidence rates of adverse outcomes, while the risk for adverse outcomes was examined using Cox multivariable regression models adjusted for age, hypertension, sex, and several comorbidities.

Those with AF diagnosed while receiving critical care had an adjusted hazard ratio of 0.93 (95% CI, 0.88-0.98; P =.009) for long-term stroke/SE and 1.73 (95% CI, 1.70-1.83; P<.001) for long-term mortality compared with those in the control group, and 1.50 (95% CI, 1.42-1.60; P <.001) and 3.20 (95% CI, 3.08-3.33; P <.001) compared with those in the no-AF group, respectively.

Excluding those with recurrent AF, those diagnosed in critical care had a significantly higher risk for stroke/SE compared with the no-AF group with an adjusted hazard ratio of 1.08 (95% CI, 1.01-1.17; P =.035). This association persisted regardless of the cause for surgery or critical care. All-cause mortality was also higher among those diagnosed in critical care compared with other groups, regardless of recurrence.

Limitations to this study include the use of ICD-10 codes for AF and adverse events, a lack of data on types of AF , a potential lack of distinction between individuals with new-onset and prior AF, a lack of concomitant medication variables, and a potentially noncomprehensive definition of recurrent atrial fibrillation.

The study researchers concluded that “[patients] with newly diagnosed [atrial fibrillation during critical care] remain at a higher risk of stroke/SE than patients without [atrial fibrillation]. The risk is increased even in those in whom recurrent [atrial fibrillation] is not documented. [Close] follow-up and considering continued use of anticoagulants might be needed in patients with newly diagnosed [atrial fibrillation during critical care].”

Disclosures: Certain authors report financial associations with pharmaceutical companies. For a full list of author disclosures, see the reference.

Reference

Kim K, Yang PS, Jang E, et al. Long-term impact of newly diagnosed atrial fibrillation during critical care: a Korean nationwide cohort study [published online April 30, 2019]. CHEST. doi:10.1016/j.chest.2019.04.011