Article,
Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study*
Affiliations
- [1] Univ Copenhagen, Dept Cardiol, Rigshosp, Copenhagen, Denmark [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
- [2] Univ Copenhagen, Dept Cardiol, Rigshosp, Copenhagen, Denmark [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
- [3] Copenhagen Univ Hosp North Zealand, Dept Anaesthesia & Intens Care, Copenhagen, Denmark [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
- [4] Tata Mem Hosp, Homi Bhabha Natl Inst, Dept Anaesthesiol Crit Care & Pain, Mumbai, India [NORA names: India; Asia, South];
- [5] Tata Mem Hosp, Homi Bhabha Natl Inst, Dept Anaesthesiol Crit Care & Pain, Mumbai, India [NORA names: India; Asia, South];
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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. INTERVENTIONS: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.