Development and validation of an automated algorithm to detect atrial fibrillation within stored intensive care unit continuous electrocardiographic data (Preprint)

BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia during critical illness, representing a sepsis-defining cardiac dysfunction associated with adverse outcomes. OBJECTIVE To develop and validate an automated algorithm to accurately identify AF within electronic healthcare data among critically ill patients with sepsis. METHODS Retrospective cohort study of patients hospitalized with sepsis identified from Medical Information Mart for Intensive Care (MIMIC III) electronic health data with linked electrocardiographic (ECG) telemetry waveforms. Within three separate cohorts of 50 patients, we iteratively developed and validated an automated algorithm that identifies ECG signals, removes noise, and identifies irregularly irregular rhythm and premature beats in order to identify AF. We compared the automated algorithm to current methods of AF identification in large databases, including ICD-9 codes and hourly nurse annotation of heart rhythm. Methods of AF identification were tested against gold standard manual ECG review. RESULTS AF detection algorithms that did not differentiate AF from premature atrial and ventricular beats performed modestly, with 76% (95% CI, 61-87%) accuracy. Performance improved (p=0.02) with the addition of premature beat detection (validation set accuracy: 94% [95% CI, 83-99%]). Median time between automated and manual detection of AF onset was 30 minutes (25th-75%ile 0-208 minutes). The accuracy of ICD-9 codes (68%, p=0.0002 vs. automated algorithm) and nurse charting (80%, p=0.02 vs. algorithm) was lower than the automated algorithm. CONCLUSIONS An automated algorithm using telemetry ECG data can feasibly and accurately detect AF among critically ill patients with sepsis, and represents an improvement in AF detection within large databases. CLINICALTRIAL na

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Cardiac Rhythm and Conduction Disturbances

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0029 ◽

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.

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Nutritional status plays a crucial role in the mortality of critically ill patients with acute renal failure

Journal of Investigative Medicine ◽

10.1136/jim-2017-000518 ◽

2017 ◽

Vol 66 (2) ◽

pp. 309-318 ◽

Cited By ~ 2

Author(s):

Haiyan Zhang ◽

Xiaodong Zhang ◽

Lei Dong

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Nutritional Status ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

Statistical Significance ◽

Nutrition Intervention ◽

Icu Discharge

We aimed to clarify associations between nutritional status and mortality in patients with acute renal failure. De-identified data were obtained from the Medical Information Mart for Intensive Care III database comprising more than 40,000 critical care patients treated at Beth Israel Deaconess Medical Centerbetween 2001 and 2012. Weight loss and body mass index criteria were used to define malnutrition. Data of 193 critically ill patients with acute renal failure were analyzed, including demographics, nutrition intervention, laboratory results, and disease severity. Main outcomes were in-hospital and 1-year mortality. The 1-year mortality was significantly higher in those with malnutrition than in those without malnutrition (50.0% vs 29.3%, p=0.010), but differences in in-hospital survival were not significant (p=0.255). Significant differences in mortality were found between those with malnutrition and without starting at the 52nd day after intensive care unit (ICU) discharge (p=0.036). No significant differences were found between men and women with malnutrition in in-hospital mortality (p=0.949) and 1-year mortality (p=0.051). Male patients requiring intervention with blood products/colloid supplements had greater risk of 1-year mortality, but without statistical significance. Nutritional status is a predictive factor for mortality among critically ill patients with acute renal failure, particularly 1-year mortality after ICU discharge.

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

Open Heart ◽

10.1136/openhrt-2019-001226 ◽

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.

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Acute Kidney Injury Associated with Combination Antimicrobial Therapy in the Medical Information Mart for Intensive Care (MIMIC) III Database

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.821 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S344-S344

Author(s):

W Cliff Rutter ◽

David S Burgess

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Hepatorenal Syndrome ◽

Medical Information ◽

Kidney Injury ◽

Rifle Criteria ◽

Multivariable Logistic Regression

Abstract Background Increased acute kidney injury (AKI) incidence is linked with coadministration of vancomycin (VAN) and piperacillin-tazobactam (TZP) in the general hospital population when compared with VAN and cefepime (FEP); however, this phenomenon was not found in critically ill patients. Methods Patients receiving VAN in combination with FEP or TZP for at least 48 hours during an intensive care unit stay were included in this retrospective review. AKI was defined with the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Exposure to common nephrotoxins was captured within 24 hours of combination therapy initiation through the entire treatment window. Basic descriptive statistics were performed, along with bivariable and multivariable logistic regression models of AKI odds. Results In total, 2230 patients were included, with 773 receiving FEP+VAN and 1457 receiving TZP+VAN. The groups were well balanced at baseline in most covariates, with the exception of hepatorenal syndrome diagnosis (TZP+VAN 1.4% vs. FEP+VAN 0.3%, P = 0.02) and vasopressor exposure (TZP+VAN 26.2% vs 21.5%, P = 0.01) being more common in the TZP+VAN group. Patients in the FEP+VAN group had a higher underlying severity of disease (Charlson comorbidity index [CCI] 2.7 vs. 2.3, P =0.0002). AKI incidence was higher in the TZP+VAN cohort (35.1% vs. 26.5%, P = 0.00004), with each stratification of the RIFLE criteria being higher. The time until onset of AKI was similar between groups (TZP+VAN median 1 [0–3] days vs. FEP+VAN 1 [0–4] days, P =0.2). After multivariable logistic regression, TZP+VAN therapy was associated with an adjust odds ratio (aOR) of AKI of 1.54 (95% confidence interval [CI] 1.25–1.89) compared with FEP+VAN. Other variables associated with increased odds of AKI included: age >= 65, duration of antibiotic therapy, higher baseline renal function, sepsis, endocarditis, hepatorenal syndrome, thiazide diuretic exposure, and increased CCI. Conclusion Treatment with TZP+VAN is associated with significant increases in AKI incidence among critically ill patients, independent of other risks for AKI. Disclosures All authors: No reported disclosures.

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

10.22541/au.161625416.61272781/v1 ◽

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

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Atrial fibrillation increased in-hospital and 4-year all-cause mortality in Critically ill patients with liver cirrhosis

10.21203/rs.3.rs-381056/v1 ◽

2021 ◽

Author(s):

Yanting Luo ◽

Bingyuan Wu ◽

Yuankai Wu ◽

Long Peng ◽

Zexiong Li ◽

...

Keyword(s):

Atrial Fibrillation ◽

Liver Cirrhosis ◽

Intensive Care ◽

Mortality Rate ◽

Critically Ill ◽

Clinical Data ◽

Critically Ill Patients ◽

Cox Regression ◽

Kaplan Meier ◽

All Cause Mortality

Abstract ObjectiveThe purpose of this study was to use a large database that contains information on patient intensive care unit (ICU) admissions to study critically ill patients with cirrhosis and the relation with atrial fibrillation and short-term and 4-year mortality. MethodsThe Monitoring in Intensive Care Database III database was used to identify patients with cirrhosis hospitalized in an ICU from 2001 to 2012. Demographic and clinical data were extracted from the database. Clinical data and demographic information were collected for each patient in our study. Kaplan-Meier analysis and multivariate Cox regression models were performed to examine the relation between atrial fibrillation and in-hospital and 4-year all-cause mortality. ResultsA total of 1,481 patients (mean age 58 years, 68% male) with liver cirrhosis treated in an ICU were included in the analysis, and the prevalence of atrial fibrillation was 14.2%. The in-hospital all-cause mortality rate was 26.60%, and patients who had a significantly higher rate of atrial fibrillation (21.57% vs. 11.50%, P < 0.001). Multivariate analysis indicated that atrial fibrillation was significantly associated with in-hospital all-cause mortality (hazard ratio [HR] = 1.52, 95% confidence interval [CI]: 1.19 to 1.95; P < 0.001), and 4-year all-cause mortality (HR = 1.55, 95% CI: 1.12 to 2.13; P = 0.008). Kaplan-Meier survival analysis showed that patients with atrial fibrillation had a significantly higher in-hospital and 4-year all-cause mortality rate than patients without atrial fibrillation. ConclusionsCritically ill patients with liver cirrhosis have a significantly increased rate of atrial fibrillation, and the presence of atrial fibrillation is an independent risk for in-hospital and 4-year all-cause mortality.

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

European Heart Journal ◽

10.1093/eurheartj/ehz748.0032 ◽

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

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

PeerJ ◽

10.7717/peerj.3716 ◽

2017 ◽

Vol 5 ◽

pp. e3716 ◽

Cited By ~ 7

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.

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