Increased long-term mortality following new-onset atrial fibrillation in the intensive care unit: A systematic review and meta-analysis

Tessa Garside; Jonathan P Bedford; Sarah Vollam; Stephen Gerry; Kim Rajappan; Peter J Watkinson

doi:10.1016/j.jcrc.2022.154161

Increased long-term mortality following new-onset atrial fibrillation in the intensive care unit: A systematic review and meta-analysis

J Crit Care. 2022 Dec:72:154161. doi: 10.1016/j.jcrc.2022.154161. Epub 2022 Oct 7.

Authors

Tessa Garside¹, Jonathan P Bedford², Sarah Vollam³, Stephen Gerry⁴, Kim Rajappan⁵, Peter J Watkinson⁶

Affiliations

¹ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; University of Sydney, New South Wales, Australia. Electronic address: tessa.garside@ndcn.ox.ac.uk.
² Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Oxford Critical Care, Oxford University Hospitals NHS Foundation Trust, UK.
³ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
⁴ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁵ Department of Cardiology, Oxford University Hospitals Trust, Oxford, UK.
⁶ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK; Oxford Critical Care, Oxford University Hospitals NHS Foundation Trust, UK.

PMID: 36215944
DOI: 10.1016/j.jcrc.2022.154161

Abstract

Purpose: We performed a systematic review and meta-analysis to investigate the long-term outcomes of patients who develop new-onset atrial fibrillation (NOAF) during an intensive care unit (ICU) admission.

Methods: We searched the MEDLINE and EMBASE databases from 2000 to 2022. We included studies of adults based in general ICUs that evaluated long-term outcomes (at least 30 days after hospital discharge) of NOAF. We excluded studies involving patients with a history of atrial fibrillation (AF). We performed risk of bias assessment of the included studies based on a modified Newcastle Ottawa score (NOS). We extracted summary data for long-term outcomes. Where the outcome was reported in three or more studies we pooled effect sizes.

Results: We screened 2206 studies and included 15 studies reporting data from 561,797 patients. Pooled analysis of 4 studies using a random effects model revealed an association between NOAF acquired in an ICU and 90-day mortality (including ICU and hospital mortality) (RR 1.53, 95% CI 1.12-2.08). We also found an association between NOAF and 1-year mortality from 7 studies (RR 1.79, 95% CI 1.65-1.96), which remained when analysing 1-year mortality in hospital survivors (RR 1.72 (95% CI 1.49-1.98).

Conclusions: In patients who develop NOAF in an ICU, both 90-day and 1-year mortality are increased in comparison to those who do not develop NOAF. Current evidence suggests an increased risk of thromboembolic events after hospital discharge in patients who develop NOAF in an ICU.

Keywords: Critical illness; Intensive care; Mortality; New-onset atrial fibrillation; Outcomes; Stroke.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Atrial Fibrillation* / etiology
Hospital Mortality
Humans
Intensive Care Units
Patient Discharge
Risk Factors

Grants and funding

NIHR300224/Department of Health/United Kingdom