1202The incidence, treatment and mortality of new-onset atrial fibrillation patients at the intensive care unit

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Jacobs ◽  
B G Loef ◽  
A C Reidinga ◽  
M J Postma ◽  
M Van Hulst ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stroke Prevention ◽  
Normal Sinus Rhythm ◽  
Real World Data ◽  
New Onset

Abstract Background Critically ill patients admitted to the intensive care unit (ICU) often develop atrial fibrillation (AF), with an incidence of around 5%. Stroke prevention in AF is well described in clinical guidelines. However, the extent to which stroke prevention is prescribed to ICU patients with AF is unknown. Purpose We aimed to determine the incidence of new-onset AF and describe the stroke prevention strategies that were initiated on the ICU of our teaching hospital. Also, we compared mortality in patients with new-onset AF to critically ill patients with previously diagnosed AF and patients without any AF. Methods This study was a retrospective cohort study including all admissions to the ICU of the our hospital in the period 2011–2016. Propensity score matching was used to compare the different patient groups. Survival analyses were performed using these real-world data. Results In total, 3334 patients were admitted to the ICU, of whom 213 patients (6.4%) developed new-onset AF. 583 patients (17.5%) had a previous diagnosis of AF, the other patients (76.1%) were in normal sinus rhythm. In-hospital mortality and one-year mortality after hospital discharge were significantly higher for new-onset AF patients compared to patients with no history of AF or previously diagnosed AF. At hospital discharge, only 50.4% of the new-onset AF-patients eligible for stroke prevention received an anticoagulant and anticoagulation was not dependent on CHA2DS2VASc score or other patient characteristics. An effect of anticoagulative status on mortality was not significant. Conclusion AF is associated with increased mortality in critically ill patients that were admitted to the ICU. More guidance is needed to optimize anticoagulant treatment in critically ill new-onset AF patients. Acknowledgement/Funding None

scholarly journals Incidence, treatment and mortality of new-onset atrial fibrillation patients at the intensive care unit

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001226
Author(s):  
Maartje S Jacobs ◽  
Bert Loef ◽  
Auke C Reidinga ◽  
Maarten J Postma ◽  
Marinus Van Hulst ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stroke Prevention ◽  
Patient Characteristics ◽  
Real World Data ◽  
New Onset

ObjectiveCritically ill patients admitted to the intensive care unit (ICU) often develop atrial fibrillation (AF), with an incidence of around 5%. Stroke prevention in AF is well described in clinical guidelines. The extent to which stroke prevention is prescribed to ICU patients with AF is unknown. We aimed to determine the incidence of new-onset AF and describe stroke prevention strategies initiated on the ICU of our teaching hospital. Also, we compared mortality in patients with new-onset AF to critically ill patients with previously diagnosed AF and patients without any AF.MethodsThis study was a retrospective cohort study including all admissions to the ICU of the Martini Hospital (Groningen, The Netherlands) in the period 2011 to 2016. Survival analyses were performed using these real-world data.ResultsIn total, 3334 patients were admitted to the ICU, of whom 213 patients (6.4%) developed new-onset AF. 583 patients (17.5%) had a previous AF diagnosis, the other patients were in sinus rhythm. In-hospital mortality and 1-year mortality after hospital discharge were significantly higher for new-onset AF patients compared with patients with no history of AF or previously diagnosed AF. At hospital discharge, only 56.3% of the new-onset AF-patients eligible for stroke prevention received an anticoagulant. Anticoagulation was not dependent on CHA2DS2-VASc score or other patient characteristics. An effect of anticoagulative status on mortality was not significant.ConclusionAF is associated with increased mortality in critically ill patients admitted to the ICU. More guidance is needed to optimise anticoagulant treatment in critically ill new-onset AF patients.

scholarly journals New-onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID-19)

2021 ◽  
Author(s):  
BİŞAR ERGÜN ◽  
BEGUM ERGAN ◽  
Melih Kaan SÖZMEN ◽  
Mehmet Nuri YAKAR ◽  
Murat KÜÇÜK ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Independent Risk Factor ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Objectives: To determine the incidence, risk factors, and outcomes of new-onset atrial fibrillation (NOAF) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). Methods: We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID-19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID-19 patients. Results: We enrolled 248 eligible patients. NOAF incidence was 14.9% (n=37), and 78% of patients (n=29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5-84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, p=0.019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40–5.09, p=0.582) Conclusions: The incidence of NOAF was 14.9% in critically ill COVID-19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID-19. Keywords: Atrial fibrillation, critical care, intensive care unit, COVID-19, mortality, hospital mortality

Cardiac Rhythm and Conduction Disturbances

2019 ◽  
pp. 197-206
Author(s):  
Yahaira Ortiz Gonzalez ◽  
Fred Kusumoto
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cardiac Arrhythmias ◽  
Cardiac Rhythm ◽  
Hemodynamic Instability ◽  
Conduction Disturbances ◽  
Ventricular Tachycardias

Patients in the intensive care unit (ICU) are exposed to several physiologic stressors that may trigger cardiac arrhythmias and lead to hemodynamic instability. Prompt recognition and initiation of appropriate therapies for arrhythmias is important because critically ill patients with arrhythmias (compared to patients without arrhythmias) have longer hospitalizations and higher mortality (30.8% vs 21.2%). Arrhythmias are classified as tachyarrhythmias or bradyarrhythmias. The most common sustained arrhythmias are supraventricular; atrial fibrillation is the most prevalent. Among the ventricular arrhythmias, up to 50% are monomorphic ventricular tachycardias.

scholarly journals Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3716 ◽  
Author(s):  
Chung Shen Chean ◽  
Daniel McAuley ◽  
Anthony Gordon ◽  
Ingeborg Dorothea Welters
Keyword(s):  
Atrial Fibrillation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Online Survey ◽  
Current Practice ◽  
Risk Scores ◽  
Online Questionnaire ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background New-onset atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. Although evidence base and expert consensus opinion for management have been summarised in several international guidelines, no specific considerations for critically ill patients have been included. We aimed to establish current practice of management of critically ill patients with new-onset AF. Methods We designed a short user-friendly online questionnaire. All members of the Intensive Care Society were invited via email containing a link to the questionnaire, which comprised 21 questions. The online survey was conducted between November 2016 and December 2016. Results The response rate was 397/3152 (12.6%). The majority of respondents (81.1%) worked in mixed Intensive Care Units and were consultants (71.8%). Most respondents (39.5%) would start intervention on patients with fast new-onset AF and stable blood pressure at a heart rate between 120 and 139 beats/min. However, 34.8% of participants would treat all patients who developed new-onset fast AF. Amiodarone and beta-blockers (80.9% and 11.6% of answers) were the most commonly used anti-arrhythmics. A total of 63.8% of respondents do not regularly anti-coagulate critically ill patients with new-onset fast AF, while 30.8% anti-coagulate within 72 hours. A total of 68.0% of survey respondents do not routinely use stroke risk scores in critically ill patients with new-onset AF. A total of 85.4% of participants would consider taking part in a clinical trial investigating treatment of new-onset fast AF in the critically ill. Discussion Our results suggest a considerable disparity between contemporary practice of management of new-onset AF in critical illness and treatment recommendations for the general patient population suffering from AF, particularly with regard to anti-arrhythmics and anti-coagulation used. Amongst intensivists, there is a substantial interest in research for management of new-onset AF in critically ill patients.

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

scholarly journals New‐onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID‐19)

2021 ◽  
Author(s):  
Bişar Ergün ◽  
Begüm Ergan ◽  
Melih Kaan Sözmen ◽  
Murat Küçük ◽  
Mehmet Nuri Yakar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Onset Atrial Fibrillation ◽  
New Onset
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