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

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.

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 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.

CHA2DS2-VASc Score and In-Hospital Mortality in Critically Ill Patients With New-Onset Atrial Fibrillation

2020 ◽  
Vol 34 (5) ◽  
pp. 1165-1171
Author(s):  
Kunal Karamchandani ◽  
Robert S. Schoaps ◽  
Thomas Abendroth ◽  
Zyad J. Carr ◽  
Tonya S. King ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals Pulmonary Hypertension an Independent Risk Factor for Death in Intensive Care Unit: Correlation of Hemodynamic Factors with Mortality

2015 ◽  
Vol 9 ◽  
pp. CCRPM.S22199 ◽  
Author(s):  
Ghulam Saydain ◽  
Aamir Awan ◽  
Palaniappan Manickam ◽  
Paul Kleinow ◽  
Safwan Badr
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Hypertension ◽  
Risk Factor ◽  
Intensive Care ◽  
Pulmonary Artery ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Independent Risk Factor ◽  
Apache Ii ◽  
Hemodynamic Parameters

Objective Critically ill patients with pulmonary hypertension (PH) pose additional challenges due to the existence of right ventricular (RV) dysfunction. The purpose of this study was to assess the impact of hemodynamic factors on the outcome. Methods We reviewed the records of patients with a diagnosis of PH admitted to the intensive care unit. In addition to evaluating traditional hemodynamic parameters, we defined severe PH as right atrial pressure >20 mmHg, mean pulmonary artery pressure >55 mmHg, or cardiac index (CI) <2 L/min/m2. We also defined the RV functional index (RFI) as pulmonary artery systolic pressure (PASP) adjusted for CI as PASP/CI; increasing values reflect RV dysfunction. Results Fifty-three patients (mean age 60 years, 72% women, 79% Blacks), were included in the study. Severe PH was present in 68% of patients who had higher Sequential Organ Failure Assessment (SOFA) score (6.8 ± 3.3 vs 3.8 ± 1.6; P = 0.001) and overall in-hospital mortality (36% vs 6%; P = 0.02) compared to nonsevere patients, although Acute Physiology and Chronic Health Evaluation (APACHE) II scores (19.9 ± 7.5 vs 18.5 ± 6.04; P = 0.52) were similar and sepsis was more frequent among nonsevere PH patients (31 vs 64%; P = 0.02). Severe PH ( P = 0.04), lower mean arterial pressure ( P = 0.04), and CI ( P = 0.01); need for invasive ventilation ( P = 0.02) and vasopressors ( P = 0.03); and higher SOFA ( P = 0.001), APACHE II ( P = 0.03), pulmonary vascular resistance index (PVRI) ( P = 0.01), and RFI ( P = 0.004) were associated with increased mortality. In a multivariate model, SOFA [OR = 1.45, 95% confidence interval (C.I.) = 1.09-1.93; P = 0.01], PVRI (OR = 1.12, 95% C.I. = 1.02-1.24; P = 0.02), and increasing RFI (OR = 1.06, 95% C.I. = 1.01-1.11; P = 0.01) were independently associated with mortality. Conclusion PH is an independent risk factor for mortality in critically ill patients. Composite factors rather than individual hemodynamic parameters are better predictors of outcome. Monitoring of RV function using composite hemodynamic factors resulting in specific interventions is likely to improve survival and needs to be studied further.

scholarly journals Clinical course after identification of new-onset atrial fibrillation in critically ill patients: a multicenter prospective cohort study

2020 ◽  
Author(s):  
Takuo Yoshida ◽  
Shigehiko Uchino ◽  
Yusuke Sasabuchi
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Cohort ◽  
Clinical Course ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract BackgroundNew-onset atrial fibrillation (AF) in critically ill patients is reportedly associated with poor outcomes. However, epidemiological data in intensive care units (ICUs) after new-onset AF identification are lacking. This study aimed to describe the clinical course after the identification of new-onset atrial fibrillation.Methods This prospective cohort study of 32 ICUs in Japan during 2017-2018 enrolled adult patients with new-onset AF. We collected data on patient comorbidities, physiological information before and at the AF onset, interventions, transition of cardiac rhythms, adverse events, and in-hospital death and stroke.Results The incidence of new-onset AF in the ICU was 2.9% (423 patients). At the AF onset, the mean atrial pressure decreased, and the heart rate increased. Sinus rhythm returned spontaneously in 84 patients (20%), and 328 patients (78%) were treated with pharmacological interventions (rate-control drugs, 67%; rhythm-control drugs, 34%). In total, 173 (40%) patients were treated with anticoagulants. Adverse events were more frequent in nonsurvivors than in survivors (bleeding: 14% vs 5%; p = 0.002, arrythmia other than AF: 6% vs 2%; p = 0.048). There were 92 (22%) and 15 patients (4%) patients who continued to have AF at 48 hours and 168 hours after onset, respectively. The hospital mortality rate of those patients were 32% and 60%, respectively. The overall hospital mortality was 26%, and the incidence of in-hospital stroke was 4.5%.Conclusions Although the proportion of patients continued to have AF within 168 hours decreased with various treatments, these patients were at a high risk of death. Moreover, adverse events occurred more frequently in nonsurvivors than in survivors. Further research to assess the management of new-onset AF in critically ill patients is strongly warranted.

scholarly journals New-Onset Atrial Fibrillation is an Independent Predictor of Mortality in Patients With Candidemia

2021 ◽  
Author(s):  
Zengli Xiao ◽  
Anqi Du ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Independent Predictor ◽  
Long Term Outcome ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background: Candidemia, or invasive candidiasis infection, is prevalent in critically ill patients and significantly contributes to the mortality and morbidity of such patients. New-onset atrial fibrillation (NOAF) also occurs frequently in critically ill patients. However, the association between NOAF and candidemia is still uncertain. This study aims to determine whether NOAF could increase the mortality rate of critically ill patients who have candidemia.Methods: We retrospectively identified NOAF in all patients who were admitted into a non-cardiac intensive care unit (ICU) and diagnosed as candidemia from January 2011 to March 2018. These patients were divided into 3 groups (NOAF, Prior AF, No AF). Clinical information and long-term outcome were collected and compared between three groups . Risk factors for these patients’ short-term and long-term mortality were also analyzed.Results: Ninety-two patients with candidemia were included from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their ICU hospitalization. Patients with NOAF had lower survival rate than those who never developed AF. The multivariate logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also an independent risk factor for 1 year mortality. Conclusions: There was a high incidence of NOAF in patients with candidemia. In this study, we found NOAF was an independent predictor of in-hospital mortality and 1 year mortality after hospital discharge for patients with candidemia.

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

Abstract 15293: Noninvasive Echocardiographic Cardiac Power Output Predicts Mortality in Cardiac Intensive Care Unit Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Barry Burstein ◽  
Vidhu Anand ◽  
Bradley Ternus ◽  
Meir Tabi ◽  
Nandan S Anavekar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Power Output ◽  
Critically Ill Patients ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Power ◽  
The Mean ◽  
Cardiac Intensive Care

Introduction: A low cardiac power output (CPO), measured invasively, identifies critically ill patients at increased risk of mortality. CPO can also be measured non-invasively with transthoracic echocardiography (TTE), although prognostic data in critically ill patients is not available. Hypothesis: Reduced CPO measured by TTE is associated with increased hospital mortality in cardiac intensive care unit (CICU) patients. Methods: Using a database of CICU patients admitted between 2007 and 2018, we identified patients with TTE within one day (before or after) of CICU admission who had data necessary for calculation of CPO. Multivariable logistic regression determined the relationship between CPO and adjusted hospital mortality. Results: We included 5,585 patients with a mean age of 68.3±14.8 years, including 36.7% females. Admission diagnoses included acute coronary syndrome (ACS) in 57%, heart failure (HF) in 50%, cardiac arrest (CA) in 12%, and cardiogenic shock (CS) in 13%. The mean left ventricular ejection fraction (LVEF) was 47±16%, and the mean CPO was 1.0±0.4 W. CPO was inversely associated with the risk of hospital mortality (Figure A), including among patients with ACS, HF, and CS (Figure B). On multivariable analysis, lower CPO was associated with higher hospital mortality (OR 0.96 per 0.1 W, 95% CI 0.0.93-0.99, p=0.03). Hospital mortality was highest in patients with low CPO coupled with reduced LVEF, increased vasopressor requirements, or higher admission lactate. Hospital mortality was higher among patients with a CPO <0.6 W (adjusted OR 1.57, 95% CI 1.13-2.19, p = 0.007), particularly in the presence of admission lactate level >4 mmol/L (50.9%). Conclusions: Echocardiographic CPO was inversely associated with hospital mortality in CICU patients, particularly among patients with increased lactate and vasopressor requirements. Routine measurement of CPO provides important information beyond LVEF and should be considered in CICU patients.

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