scholarly journals Slow Down: New-Onset Atrial Fibrillation Challenges for Ambulatory Surgical Facilities

2021 ◽  
pp. 39-41
Author(s):  
Melanie Motts ◽  
Lea Anne Gardner
Keyword(s):  
Atrial Fibrillation ◽  
Patient Safety ◽  
Healthcare Facilities ◽  
Safety Reporting ◽  
Cardiac Monitor ◽  
Medical Issues ◽  
Increased Risk ◽  
Act One ◽  
Onset Atrial Fibrillation ◽  
New Onset

As patient safety liaisons (PSLs), we are continually educating and collaborating with our Pennsylvania healthcare facilities. We often are asked questions about reportable events under the Medical Care Availability and Reduction of Error (MCARE) Act. One of the most common examples we discuss is cancellations and transfers out of an ambulatory surgical facility (ASF). The top three reasons for cancellations include preop instructions not followed, missed medical issues identified during preop screening, and no shows. The top three reasons for transfers include cardiac arrhythmias, aspiration, and hypertension. Interestingly, between discussions with facilities and review of event reports, new-onset atrial fibrillation (AF) has come up often as a common reason for cancellations or transfers out of the ASF setting, especially in gastrointestinal (GI) procedures. In fact, as PSLs, when educating ASFs on reportable events we often give the example of placing a patient on the cardiac monitor in preop and the patient is found to be in AF. In 2009, it was estimated that 13.1% of AF cases were undiagnosed,3 which may explain why patients are presenting with new-onset AF. People with AF are at an increased risk of complications (e.g., stroke);3,4 therefore, a cancellation or transfer may be necessary depending on the patient’s condition. These events are considered reportable to the Pennsylvania Patient Safety Reporting System (PA-PSRS) under MCARE.

scholarly journals Cancellations and Transfers Related to New-Onset Atrial Fibrillation: An Analysis of Survey and Patient Safety Reporting Data From Ambulatory Surgical Facilities

2021 ◽  
pp. 28-38
Author(s):  
Lea Anne Gardner ◽  
Rebecca Jones ◽  
Melanie Motts
Keyword(s):  
Atrial Fibrillation ◽  
Patient Safety ◽  
Safety Issue ◽  
Future Research ◽  
Safety Reporting ◽  
Increased Risk ◽  
Rapid Heart Rate ◽  
Patient Safety Issue ◽  
Reporting Data ◽  
New Onset

Atrial fibrillation (AF) is a cardiac arrhythmia characterized by an irregular rhythm and often rapid heart rate. People with AF can be symptomatic or asymptomatic and are at increased risk for stroke. In this study, we used two data sources—a survey and Pennsylvania Patient Safety Reporting System (PA-PSRS) reports—to examine new-onset AF in Pennsylvania ambulatory surgical facilities (ASFs). The survey was developed and conducted to learn more about new-onset AF– related cancellations and transfers in Pennsylvania ASFs and to update the Patient Safety Authority ASF Cancellation and Transfer Tracking Tool. The survey response rate was 53.1%, with 50.9% of respondents indicating new-onset AF–related cancellations in the last year. A five-year review of PA-PSRS data revealed an increase in the number of new-onset AF–related cancellation and transfer events that occurred in the last two years. In 70.9% of the reports, patients were 65 years of age and older. A paucity of research on this patient safety issue led us to identify areas for future research.

scholarly journals Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2927
Author(s):  
Amaar Obaid Hassan ◽  
Gregory Y. H. Lip ◽  
Arnaud Bisson ◽  
Julien Herbert ◽  
Alexandre Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

scholarly journals The Association of New-Onset Atrial Fibrillation and Risk of Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mengxia Zhang ◽  
Lin-ling Li ◽  
Qian-qian Zhao ◽  
Xiao-dong Peng ◽  
Kui Wu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Meta Analysis ◽  
Large Sample Size ◽  
Systematic Analysis ◽  
Incident Cancer ◽  
Increased Risk ◽  
Risk Of Cancer ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background. There are distinct results for the relationship between new-onset atrial fibrillation (NOAF) and subsequent incident cancer. To date, no systematic analysis has been conducted on this issue. This study aims to explore the relationship between NOAF and the risk of developing cancer through a meta-analysis with a large sample size. Methods. Electronic databases, such as PubMed and EMBASE, were searched for published relevant studies on NOAF patients diagnosed with cancer after and during follow-ups, including reported records of baseline information and the statistical result of morbidity. Two investigators independently reviewed the articles and extracted the data using uniform standards and definitions. The meta-analysis was conducted using the Cochrane Program Review Manager. Results. This meta-analysis consisted of five cohort studies and one case-control study, which comprised 533,514 participants. The pooled relative risk (RR) for incident cancer was 1.24 (95% CI: 1.10–1.39, P=0.0003). The temporal trend analysis demonstrated that an increased risk of cancer was observed during the initial 90 days (RR: 3.44, 95% CI: 2.29–5.57, P<0.00001), but not after that. Lung cancer (RR: 1.51, 95% CI: 1.47–1.55, P<0.00001) was associated with NOAF, but not colorectal cancer and breast cancer. Conclusion. This meta-analysis provides evidence that NOAF is associated with increased risk of cancer. The risk of incident cancer particularly increases within 90 days after NOAF diagnosis, but not after that.

P945Abnormalities in ankle-brachial indices are independently associated with new-onset atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Tseng ◽  
M Girardo ◽  
D Atwal ◽  
C Firth ◽  
J Shipman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hazard Analysis ◽  
Chronic Kidney Disease Stage ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Disease Stage ◽  
Chronic Obstructive ◽  
Increased Risk ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Introduction Lower extremity physiologic studies are an important non-invasive diagnostic tool in peripheral arterial disease (PAD). PAD and atrial fibrillation (AF) are associated with increased cardiovascular and all-cause mortality. Purpose To evaluate the association between PAD and new-onset AF and the risk of stroke. Methods We performed a study of all patients without AF undergoing ankle-brachial index (ABI) for any indication between January 1996 to June 2018. The ABI cut-off were as follows: abnormal ABI (0–0.99), normal ABI (1.00–1.39) and poor vessel compressibility (PC) (1.40+). Demographic, comorbidity, and outcome variables were extracted using the electronic medical record. Results Overall, 34,441 patients (mean age 66.8±14.3, 57.3% male, 88.2% white) were included in the study with a median follow-up of 7.2 years (interquartile range, 3.0–12.9 years). Multivariate Cox proportional hazard analysis showed increased risk of new-onset AF for male sex, older age, hypertension, coronary artery disease, cerebrovascular disease, chronic kidney disease stage III or greater, congestive heart failure, chronic obstructive pulmonary disease, and cancer (all p<0.0001). After adjustment, ABI results were significantly associated with new-onset AF, particularly poorly-compressible vessels (adjusted HR: 1.42 (1.30–1.55), p<0.0001) compared to abnormal ABI (adjusted HR: 1.12 (1.05–1.20), p=0.0012). Patients with atrial fibrillation were more likely to experience ischemic stroke (39.2% versus 16.1%, p<0.0001). Conclusion Abnormalities in ABI results, particularly poorly-compressible vessels, are independently associated with new-onset atrial fibrillation in a large ambulatory cohort. While the mechanism cannot be assessed, common inflammatory mechanisms and increased vascular stiffness may play an important role. Identification of AF in these at-risk patients may improve cardiovascular outcomes.

Chronic Osteomyelitis Is Associated With Increased Risk of New-Onset Atrial Fibrillation: Evidence From a Nationwide Cohort of 23 Million People

2016 ◽  
Vol 32 (12) ◽  
pp. 1388-1395 ◽  
Author(s):  
Lien-Cheng Hsiao ◽  
Chih-Hsin Muo ◽  
Che-Yi Chou ◽  
Chun-Hung Tseng ◽  
Ming-Fong Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Osteomyelitis ◽  
Increased Risk ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals Usefulness of C-reactive protein/albumin ratio as a predictor of new-onset atrial fibrillation in SARS coronavirus-2

2021 ◽  
Author(s):  
Saban Kelesoglu ◽  
Yucel Yilmaz ◽  
Eyup Ozkan ◽  
Bekir Calapkorur ◽  
Zehra B Dursun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Independent Predictor ◽  
Multivariate Logistic Regression Analysis ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Increased Risk ◽  
High Level ◽  
Onset Atrial Fibrillation ◽  
New Onset

Aim: To investigate whether C-reactive protein/albumin ratio (CAR) has an association with new onset atrial fibrillation (NOAF) in SARS-CoV-2. Materials & methods: This study included 782 patients with SARS-CoV-2 infection, who were hospitalized in Turkey. The end point of the study was an occurrence of NOAF. Results: NOAF was identified in 41 patients (5.2%). Subjects who developed NOAF had a higher CAR compared with those who did not develop NOAF (p < 0.001). In the multivariate logistic regression analysis the CAR (odds ratio = 2.879; 95% CI: 1.063–7.793; p = 0.037) was an independent predictor of NOAF. Conclusion: A high level of CAR in blood samples is associated with an increased risk of developing NOAF in SARS-CoV-2.

scholarly journals Time-Dependent Risk of Atrial Fibrillation in Patients With Primary Aldosteronism After Medical or Surgical Treatment Initiation

Hypertension ◽  
2021 ◽  
Author(s):  
Kyoung Jin Kim ◽  
Namki Hong ◽  
Min Heui Yu ◽  
Hokyou Lee ◽  
Seunghyun Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Essential Hypertension ◽  
Receptor Antagonist ◽  
Primary Aldosteronism ◽  
Mineralocorticoid Receptor ◽  
Time Dependent ◽  
Mineralocorticoid Receptor Antagonist ◽  
Increased Risk ◽  
Onset Atrial Fibrillation ◽  
New Onset

Increased risk of atrial fibrillation was reported in patients with primary aldosteronism. However, data are limited regarding the time-dependent risk of atrial fibrillation in surgically or medically treated primary aldosteronism. From the National Health Insurance Claim database in Korea (2003–2017), a total of 1418 patients with primary aldosteronism (adrenalectomy [ADX], n=755, mineralocorticoid receptor antagonist n=663) were age- and sex-matched at a 1:5 ratios to patients with essential hypertension (n=7090). Crude incidence of new onset atrial fibrillation was 2.96% in primary aldosteronism and 1.97% in essential hypertension. Because of nonproportional hazard observed in new onset atrial fibrillation, analysis time was split at 3 years. Compared with essential hypertension, risk of new onset atrial fibrillation peaked at 1 year gradually declined but remained elevated up to 3 years in overall treated primary aldosteronism (adjusted hazard ratio [aHR] 3.02; P <0.001) as well as in both ADX (aHR, 3.54; P <0.001) and mineralocorticoid receptor antagonist groups (aHR 2.27; P =0.031), which became comparable to essential hypertension afterward in both groups (ADX aHR, 0.38; P =0.102; mineralocorticoid receptor antagonist aHR, 0.60; P =0.214). Nonetheless, mineralocorticoid receptor antagonist group was associated with increased risk of nonfatal stroke (aHR, 1.21; P =0.031) compared with essential hypertension, whereas ADX was not (aHR, 1.26; P =0.288). Our results suggest the risk of new-onset atrial fibrillation remained elevated up to 3 years in treated primary aldosteronism compared with essential hypertension, which declined to comparable risk in essential hypertension thereafter. Monitoring for atrial fibrillation up to 3 years after treatment, particularly ADX, might be warranted.

scholarly journals An Audit on "Atrial Fibrillation & Anti-Coagulation" at University Hospitals of North Midlands NHS Trust (2015-2017)

2020 ◽  
pp. 1-3
Author(s):  
M.I.A Qureshi ◽  
M.I.A Qureshi ◽  
Anil Kumar ◽  
Anil K Miryala
Keyword(s):  
Atrial Fibrillation ◽  
Patient Safety ◽  
Subdural Haematoma ◽  
Significant Risk ◽  
Analysis Data ◽  
University Hospital ◽  
Prospective Audit ◽  
University Hospitals ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: During hospital admission, it was noticed that most patients with atrial fibrillation (new or old) diagnosis have no clear documented plan about anticoagulation. It was considered a significant risk for patient safety. Aim: To determine whether patients with atrial fibrillation diagnosis were on anticoagulation or not, if not have the reasons been documented in the medical notes. If new-onset atrial fibrillation whether CHADSVASC and HASBLED scores have been used or not for anticoagulation purpose. Settings: County Hospital Stafford & Royal Stoke University Hospital (UHNM 2015-2017). Materials and Methods: Prospective audit, a total of 100 patient's data (50 patients per cycle) were analysed by using specific audit Performa based upon NICE Atrial Fibrillation 2014 Guidelines [1]. Statistical Analysis: Data was coded, entered in an excel spreadsheet and analysed by translating into percentages and proportions. Results: Initial audit showed that out of 50 patients with atrial fibrillation diagnosis, 30 were already on anticoagulation and 20 were not on anticoagulation. Only 2 out of 20 were assessed for anticoagulation and 18 were not assessed. AF Performa was introduced in the clerking sheet post initial audit. Re-audit after 6 months showed 43 out of 50 patients were on anticoagulation and 7 were not. Out of these 7 patients, 3 patients had absolute contraindications (Subdural Haematoma, Rectal bleeding and major haematoma), 2 patients were assessed for anticoagulation however were not followed up and 2 were not assessed. Results comparison is explained in (Table 1). Conclusions: This audit has demonstrated significant improvement in overall anticoagulation rates in suitable patients which have helped in improving patient safety.

scholarly journals Subclinical Measures of Peripheral Atherosclerosis and the Risk of New‐Onset Atrial Fibrillation in the General Population: the Rotterdam Study

2021 ◽  
Author(s):  
Sven Geurts ◽  
Cathrine Brunborg ◽  
Grigorios Papageorgiou ◽  
M. Arfan Ikram ◽  
Maryam Kavousi
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Carotid Plaque ◽  
Population Based ◽  
Rotterdam Study ◽  
Link Type ◽  
Increased Risk ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background Limited population‐based data on the (sex‐specific) link between subclinical measures of peripheral atherosclerosis and new‐onset atrial fibrillation (AF) exist. Methods and Results Subclinical measures of peripheral atherosclerosis including carotid intima‐media thickness (cIMT), carotid plaque, and ankle‐brachial index (ABI) were assessed at baseline and follow‐up examinations. A total of 12 840 participants free of AF at baseline from the population‐based Rotterdam Study were included. Cox proportional hazards models and joint models, adjusted for cardiovascular risk factors, were used to determine the associations between baseline and longitudinal measures of cIMT, carotid plaque, and ABI with new‐onset AF. During a median follow‐up of 9.2 years, 1360 incident AF cases occurred among 12 840 participants (mean age 65.2 years, 58.3% women). Higher baseline cIMT (fully‐adjusted hazard ratio [HR], 95% CI, 1.81, 1.21–2.71; P =0.0042), presence of carotid plaque (fully‐adjusted HR, 95% CI, 1.19, 1.04–1.35; P =0.0089), lower ABI (fully‐adjusted HR, 95% CI, 1.57, 1.14–2.18; P =0.0061) and longitudinal measures of higher cIMT (fully‐adjusted HR, 95% CI, 2.14, 1.38–3.29; P =0.0021), presence of carotid plaque (fully‐adjusted HR, 95% CI, 1.61, 1.12–2.43; P =0.0112), and lower ABI (fully‐adjusted HR, 95% CI, 4.43, 1.83–10.49; P =0.0007) showed significant associations with new‐onset AF in the general population. Sex‐stratified analyses showed that the associations for cIMT, carotid plaque, and ABI were mostly prominent among women. Conclusions Baseline and longitudinal subclinical measures of peripheral atherosclerosis (carotid atherosclerosis, and lower extremity peripheral atherosclerosis) were significantly associated with an increased risk of new‐onset AF, especially among women. Registration URL: https://www.trialregister.nl , https://www.apps.who.int/trialsearch/ ; Unique identifier: NL6645/NTR6831.

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