Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study

Jonathan P Bedford; Tessa Garside; Julie L Darbyshire; Timothy R Betts; J Duncan Young; Peter J Watkinson

doi:10.1177/17511437211022132

Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study

J Intensive Care Soc. 2022 Nov;23(4):414-424. doi: 10.1177/17511437211022132. Epub 2021 Jun 3.

Authors

Jonathan P Bedford¹, Tessa Garside¹, Julie L Darbyshire¹, Timothy R Betts², J Duncan Young¹, Peter J Watkinson^{1

3}

Affiliations

¹ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
² Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
³ NIHR Oxford Biomedical Research Centre, Oxford, UK.

Abstract

Background: New-onset atrial fibrillation (NOAF) is common during critical illness and is associated with poor outcomes. Many risk factors for NOAF during critical illness have been identified, overlapping with risk factors for atrial fibrillation in patients in community settings. To develop interventions to prevent NOAF during critical illness, modifiable risk factors must be identified. These have not been studied in detail and it is not clear which variables warrant further study.

Methods: We undertook an international three-round Delphi process using an expert panel to identify important predictors of NOAF risk during critical illness.

Results: Of 22 experts invited, 12 agreed to participate. Participants were located in Europe, North America and South America and shared 110 publications on the subject of atrial fibrillation. All 12 completed the three Delphi rounds. Potentially modifiable risk factors identified include 15 intervention-related variables.

Conclusions: We present the results of the first Delphi process to identify important predictors of NOAF risk during critical illness. These results support further research into modifiable risk factors including optimal plasma electrolyte concentrations, rates of change of these electrolytes, fluid balance, choice of vasoactive medications and the use of preventative medications in high-risk patients. We also hope our findings will aid the development of predictive models for NOAF.

Keywords: Atrial fibrillation; Delphi; critical care; intensive care; risk factors.