open access publication

Article, 2023

Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study*

Critical Care Medicine, ISSN 1530-0293, 0090-3493, Volume 51, 9, Pages 1124-1137, 10.1097/ccm.0000000000005883

Contributors

Wetterslev, Mik 0000-0002-8798-1133 (Corresponding author) [1] [2] Møller, Morten Hylander [1] [2] Granholm, Anders 0000-0001-5799-7655 [1] [2] Hassager, Christian 0000-0002-1199-0981 [1] [2] Haase, Nicolai Rosenkrantz Segelcke 0000-0002-8176-404X [1] [2] Lange, Theis 0000-0001-6807-8347 [2] Myatra, Sheila Nainan 0000-0001-6761-163X [3] [4] Hästbacka, Johanna R 0000-0002-3613-7231 [5] Arabi, Yaseen M. [6] Shen, Jiawei [7] Cronhjort, Maria B 0000-0002-0444-8553 [8] Lindqvist, Elin 0009-0003-9139-3734 [8] Aneman, Anders E M 0000-0003-2096-5304 [9] [10] Young, Paul Jeffrey 0000-0002-3428-3083 [11] [12] Szczeklik, Wojciech K 0000-0002-1349-1123 [13] Siegemund, Martin 0000-0002-2013-4140 [14] Koster, Thijs M [15] Aslam, Tayyba Naz 0000-0002-1376-1533 [16] Bestle, Morten Heiberg 0000-0001-6585-2659 [2] [17] Girkov, Mia Seremet [2] Kalvit, Kushal Rajeev [3] [4] Mohanty, Rakesh [3] [4] Mascarenhas, Joanne M [18] Pattnaik, Manoranjan [19] Vergis, Sara 0000-0002-9193-9819 [20] Haranath, Sai Praveen P 0000-0001-9137-9201 [21] Shah, Mehul Shirish 0000-0002-0720-7632 [22] Joshi, Ziyokov [23] Wilkman, Erika 0000-0003-4250-7523 [5] Reinikainen, Matti T 0000-0001-6878-3740 [24] [25] Lehto, Pasi M [26] Jalkanen, Ville 0000-0002-7819-6192 [27] Pulkkinen, Anni [28] An, You-Zhong [7] Wang, Guoxing [29] [30] Huang, Lei [31] Huang, Bin [31] Liu, Wei [30] Gao, Hengbo [32] Dou, Lin [33] Li, Shuangling [34] Yang, Wanchun [35] Tegnell, Emily [36] Knight, Agnes [37] Czuczwar, Mirosław 0000-0002-9025-6717 [38] Czarnik, Tomasz 0000-0002-6734-978X [39] Perner, Anders [1] [2] Collaborators, The Afib-Icu

Affiliations

  1. [1] Rigshospitalet
    2. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] University of Copenhagen
    3. [NORA names: KU University of Copenhagen; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Homi Bhabha National Institute
    4. [NORA names: India; Asia, South];
  4. [4] Tata Memorial Hospital
    5. [NORA names: India; Asia, South];
  5. [5] Helsinki University Hospital
    6. [NORA names: Finland; Europe, EU; Nordic; OECD];

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.

Keywords

Atrial, ICU, ICU admission, ICU patients, International, admission, adults, amiodarone, analysis, arterial hypertension, associated with 90-day mortality, associated with AF, associated with different conditions, associated with worse outcomes, atrial fibrillation, beta 1-selective blocker, bleeding events, blockers, bolus, calcium, cardiac surgery, cardioversion, cause-specific hazard ratios, conditions, continuous electrocardiogram monitoring, countries, different conditions, digoxin, disease, disease severity, electrocardiogram monitoring, episodes, episodes of AF, events, factors, fibrillation, fluid bolus, geographic regions, hazard ratio, higher mortality, history, history of arterial hypertension, hypertension, inception, inception period, incidence, incidence of AF, intervention, magnesium, management, management of AF, management strategies, monitoring, mortality, outcomes, outcomes of atrial fibrillation, paroxysmal AF, patients, period, persistent/permanent AF, potassium, practice, ratio, region, risk, risk factors, selective blockers, sepsis, severe bleeding events, severity, strategies, surgery, thromboembolism, variation, worse outcomes

Funders

  • Southern and Eastern Norway Regional Health Authority

Data Provider: Digital Science

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