Abstract
BackgroundNew-onset atrial fibrillation (NOAF) is common in patients on an intensive care unit (ICU). Evidence guiding treatments is limited, though recent reports suggest beta blocker (BB) therapy is associated with reduced mortality.MethodsWe conducted a multicentre cohort study of adult patients admitted to 3 ICUs in the UK and 5 ICUs in the USA. We analysed the haemodynamic changes associated with NOAF. We analysed rate control, rhythm control, and hospital mortality associated with common NOAF treatments. We balanced admission and post-NOAF, pre-treatment covariates across treatment groups.ResultsNOAF was followed by a systolic blood pressure reduction of 5 mmHg (p < 0.001). After adjustment, digoxin therapy was associated with inferior rate control versus amiodarone (adjusted hazard ratio (aHR) 0.56, [95% CI 0.34–0.92]). Calcium channel blocker (CCB) therapy was associated with inferior rhythm control versus amiodarone (aHR 0.59 (0.37–0.92). No difference was detected between BBs and amiodarone in rate control (aHR 1.15 [0.91–1.46]), rhythm control (aHR 0.85, [0.69–1.05]), or hospital mortality (aHR 1.03 [0.53–2.03]).ConclusionsNOAF in ICU patients is followed by decreases in blood pressure. BBs and amiodarone are associated with similar cardiovascular control and appear superior to digoxin and CCBs. Accounting for key confounders removes previously reported mortality benefits associated with BB treatment.
Highlights
New-onset atrial fibrillation (NOAF) is a common complication of critical illness, occurring in around 15% of intensive care unit (ICU) admissions [1]
We aimed to describe the characteristics of NOAF and compare the effectiveness of NOAF treatments in patients on an ICU accounting for physiological status after NOAF
Rate control Digoxin therapy was associated with inferior rate control (adjusted hazard ratio 0.56 [95% CI 0.34–0.92]) all in the United Kingdom (UK) database (Fig. 3) in comparison to amiodarone
Summary
New-onset atrial fibrillation (NOAF) is a common complication of critical illness, occurring in around 15% of intensive care unit (ICU) admissions [1]. Incidence is higher in certain patient groups, such as Abbreviations: AF, Atrial fibrillation; NOAF, New-onset atrial fibrillation; ICU, Intensive care unit; HR, Hazard ratio; aHR, Adjusted hazard ratio; USA, United States of America; UK, United Kingdom. Guidelines exist for management of AF in patients in the community This is not the case in the critical care setting, where the risks and benefits associated with different treatment options remain unclear, with no large scale trials undertaken [6]. New-onset atrial fibrillation (NOAF) is common in patients on an intensive care unit (ICU). Rhythm control, and hospital mortality associated with common NOAF treatments. Accounting for key confounders removes previously reported mortality benefits associated with BB treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
