Abstract
BackgroundNew-onset atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. Although evidence base and expert consensus opinion for management have been summarised in several international guidelines, no specific considerations for critically ill patients have been included. We aimed to establish current practice of management of critically ill patients with new-onset AF.MethodsWe designed a short user-friendly online questionnaire. All members of the Intensive Care Society were invited via email containing a link to the questionnaire, which comprised 21 questions. The online survey was conducted between November 2016 and December 2016.ResultsThe response rate was 397/3152 (12.6%). The majority of respondents (81.1%) worked in mixed Intensive Care Units and were consultants (71.8%). Most respondents (39.5%) would start intervention on patients with fast new-onset AF and stable blood pressure at a heart rate between 120 and 139 beats/min. However, 34.8% of participants would treat all patients who developed new-onset fast AF. Amiodarone and beta-blockers (80.9% and 11.6% of answers) were the most commonly used anti-arrhythmics. A total of 63.8% of respondents do not regularly anti-coagulate critically ill patients with new-onset fast AF, while 30.8% anti-coagulate within 72 hours. A total of 68.0% of survey respondents do not routinely use stroke risk scores in critically ill patients with new-onset AF. A total of 85.4% of participants would consider taking part in a clinical trial investigating treatment of new-onset fast AF in the critically ill.DiscussionOur results suggest a considerable disparity between contemporary practice of management of new-onset AF in critical illness and treatment recommendations for the general patient population suffering from AF, particularly with regard to anti-arrhythmics and anti-coagulation used. Amongst intensivists, there is a substantial interest in research for management of new-onset AF in critically ill patients.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia in both the general population and the critical care setting (Makrygiannis et al, 2014; Seguin et al, 2004)
Questionnaires were sent to 3,152 members of the Intensive Care Society (ICS) who had updated email addresses available
Our results indicate that mainly senior medical staff responded to the survey invitation, with Consultants representing 71.8% of respondents; 53.9% had more than 10 years of experience in Critical Care
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia in both the general population and the critical care setting (Makrygiannis et al, 2014; Seguin et al, 2004). Despite the relatively high incidence of new-onset AF among critically ill patients, there is paucity of evidence for its management in the critical care setting. New-onset atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. A total of 63.8% of respondents do not regularly anti-coagulate critically ill patients with new-onset fast AF, while 30.8% anti-coagulate within 72 hours. A total of 68.0% of survey respondents do not routinely use stroke risk scores in critically ill patients with new-onset AF. Our results suggest a considerable disparity between contemporary practice of management of new-onset AF in critical illness and treatment recommendations for the general patient population suffering from AF, with regard to antiarrhythmics and anti-coagulation used. There is a substantial interest in research for management of new-onset AF in critically ill patients
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