Abstract
Background: Atrial fibrillation (AF) is common after cardiac surgery and has been associated with poor outcome and increased resource utilization. The main objective of this study is to determine the incidence of POAF in Malaysia and identify the predictors of developing POAF. The secondary outcome of this study would be to investigate the difference in mortality and morbidity rates and the duration of intensive care unit (ICU), high dependency unit (HDU) and hospital stay between the two. Methods: This is a retrospective single-center, cross sectional study conducted at the National Heart Institute, Malaysia. Medical records of 637 who underwent coronary artery bypass grafting (CABG) surgery in 2015 were accrued. Pre-operative, operative and post-operative information were subsequently collected on a pre-formulated data collection sheet. Data were then analyzed using IBM SPSS v23. Results: The incidence of POAF in our study stands at 28.7% with a mean onset of 45±33 hours post operatively. Variables with independent association with POAF include advancing age, Indian population, history of chronic kidney disease, left ventricular ejection fraction and beta-blocker treatment. The mortality rate is significantly higher statistically (p < 0.05), and similarly the incidence of stroke. The incidence of other post-operative complications was also significantly higher statistically. The duration of ICU, HDU and hospital stays were statistically longer (p < 0.001) with higher rates of ICU readmissions and reintubations seen. Conclusion: We conclude that the incidence of POAF in Malaysia is comparable to the figures in Western countries, making POAF one of the most commonly encountered condition after CABG with similar higher rates of mortality, poor outcomes and longer duration of stay, and therefore increased cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery with a reported incidence of 15–40%, a significant leap in incidence compared to the normal population[1]
We found that advancing age, history of chronic kidney disease (CKD), non-Indian populations, low left ventricular ejection fraction and pre-operative beta-blocker treatment are independently associated with the development of post operative atrial fibrillation (POAF)
A number of preoperative patients’ characteristics and intraoperative practice variables appear to affect the incidence of this arrhythmia
Summary
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery with a reported incidence of 15–40%, a significant leap in incidence compared to the normal population[1]. Stroke remains the main morbid event for POAF, as the recurrence rate for stroke stands at 20% per year regardless of whether it is chronic or intermittent AF. Other complications such as post-operative congestive heart failure, renal failure, infection and neurological changes all experienced significant increases in patients with POAF2,7. Conclusion: We conclude that the incidence of POAF in Malaysia is comparable to the figures in Western countries, making POAF one of the most commonly encountered condition after CABG with similar higher rates of mortality, poor outcomes and longer duration of stay, and increased cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and lower cost of care
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