CE-452778-2 LONG-TERM MORBIDITY AND MORTALITY ASSOCIATED WITH POSTOPERATIVE ATRIAL FIBRILLATION: AN ANALYSIS FROM THE SWEDEHEART SWEDISH CARDIAC SURGERY REGISTRY

Abstract

Postoperative atrial fibrillation (POAF) following cardiac surgery is a common complication associated with longer hospital stays and higher healthcare resource utilization. Much of the current literature focuses on the short-term consequences of POAF while long-term morbidity and mortality are not as well described. To assess long-term morbidity and mortality associated with POAF following open-heart surgery. A retrospective study was conducted using the SWEDEHEART Swedish Cardiac Surgery Registry and several other Swedish national health registries. The study sample consisted of patients aged 55 to 90 years who underwent open-chest coronary artery bypass and/or valvular surgery between 2010 and 2019. Patients with a preoperative history of permanent or persistent AF were excluded. Patients who experienced POAF were compared with those who did not. Risk of recurrent AF, heart failure, chronic kidney disease, ischemic stroke, major bleed and mortality were compared between the cohorts. Outcomes were adjusted for differences in baseline demographics and clinical history using multivariable Cox regression. Data extraction was conducted by the Uppsala Clinical Research Center and the Swedish National Board of Health and Welfare. A total of 30,870 patients with a mean age of 69.9 years were included in the study, of which 10,136 (32.8%) patients composed the POAF group. The median follow-up was 4.6 years. After adjustment, patients who experienced POAF had a significantly higher risk of recurrent AF (HR 2.30; 95% CI 2.21, 2.41), heart failure (HR 1.17; 95% CI 1.10, 1.25), chronic kidney disease (HR 1.15; 95% CI 1.07, 1.24), all-cause mortality (HR 1.11; 95% CI 1.04, 1.18), and cardiovascular mortality (HR 1.16; 95% CI 1.06, 1.26). POAF was associated with a numerically higher risk of ischemic stroke (HR 1.07; 95% CI 0.96, 1.20) and major bleed (HR 1.11; 95% CI 0.98, 1.25), but these findings were not statistically significant. Over a median of 4.6 years of follow-up in Swedish cardiac surgery patients, POAF was associated with a statistically significantly higher risk of long-term recurrent AF, heart failure, chronic kidney disease, and all-cause and cardiovascular mortality.