An observational study of the management practices and outcomes of patients with new onset atrial fibrillation in non-cardiothoracic surgeries

Heart Lung. 2020 May-Jun;49(3):304-308. doi: 10.1016/j.hrtlng.2019.10.014. Epub 2019 Nov 15.

Abstract

Background and objective: Limited data exist on characteristics and management of patients with postoperative atrial fibrillation (POAF) after noncardiothoracic surgeries and on the relationship between symptoms and outcomes. We sought to describe clinical features, in-hospital practices and outcomes in patients with new POAF by the presence or absence of clinical symptoms.

Methods: Retrospective cohort study of adults with POAF in one tertiary center.

Results: Among the 99 patients who fulfilled the eligibility criteria, median age was 75 years (IQR 64-83) and 57.6% were male. Only thirty percent of patients with POAF were symptomatic. Rate control/conversion to sinus rhythm was achieved in ≤ 4 h in 56% of the patients and in 80% was maintained for ≥ 24 h. Anticoagulation was prescribed in 50% of those discharged in AF; the CHADS2-VASc score was not associated with anticoagulation prescribed. One third of patients were readmitted and half of them were in AF. Asymptomatic patients had lower median heart rate than symptomatic patients but no other clinical characteristics, or outcomes were different.

Conclusions: Most patients with POAF were asymptomatic but their presentation or outcomes were similar with symptomatic patients. One in four discharged patients was prescribed anticoagulation and the CHADS2-VASC score was not associated with this decision. These findings have important implications for practice and future research. There is a need to better delineate the risk associated with transient versus persistent POAF, symptomatic versus asymptomatic POAF, as well as for clinical trials to determine optimal strategies to improve their outcomes.

Keywords: Atrial fibrillation; Noncardiac surgery; Postoperative.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors