Abstract 160: Atrial Fibrillation After Cardiac Arrest is Associated With Increased Risk of Mortality and Stroke

Abstract

Introduction: The presence of atrial fibrillation (AF) in the first 2 days after resuscitation from cardiac arrest has been associated with increased mortality. However, whether new onset AF diagnosed in the first days to weeks after ROSC is associated with mortality or stroke is unknown. Our aim was to determine the incidence of new AF diagnoses after cardiac arrest and its impact on mortality and ischemic stroke. Methods: Retrospective observation cohort study using COSMOS, an Epic-based EHR database with >190 million deidentified patients from 5/18/2020 to 4/1/2023. Patients with an ICD-10 diagnosis of cardiac arrest (ICD-10 I46.*) without prior history of AF were included. Two groups were examined: 1) AF diagnosis (ICD 10 I48*) made within 48 hours and 2) within 14 days after index cardiac arrest. We examined mortality and incidence of ischemic stroke at 1, 3, 6, and 12 months. Statistical comparisons were made using Chi-squared analysis. Results: Among 410,850 cardiac arrest patients without prior history of AF, 16,498 received a new AF diagnosis within 14 days (4%). The mean age was 68 yrs. with 64% male, 72% white. Mortality at one year in patients who developed AF by post-arrest day 14 was 54.5% vs. 39.5% in patients with no AF diagnosis (p<.00001). The one-year incidence of stroke in patients with AF at 48 hours was 7.9%, similar to patients who had AF at 14 days (7.3%, p=NS). Moreover, stroke was diagnosed within 14 days of cardiac arrest in 5.4% of AF patients. Importantly, in these patients with stroke, 7% received anticoagulation with warfarin or direct oral anticoagulation, while the remaining 93% were not anticoagulated (p<.00001), suggesting that consideration of early anticoagulation is imperative. Conclusion: AF diagnosed after cardiac arrest is associated with increased mortality. Patients who develop AF after cardiac arrest have significant short and long-term ischemic stroke risk, which is markedly decreased by anticoagulation. These data suggest that vigilance is required for patients who develop persistent AF after cardiac arrest, particularly stroke risk and prevention, as well as the consideration of an early rhythm control strategy.