574726
research-article2015
AOPXXX10.1177/1060028015574726Annals of PharmacotherapyChen et al
Research Report
New-Onset Atrial Fibrillation Is an Independent Predictor of Mortality in Medical Intensive Care Unit Patients
Annals of Pharmacotherapy 2015, Vol. 49(5) 523–527 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028015574726 aop.sagepub.com
Alyssa Y. Chen, PharmD1, Sarah S. Sokol, PharmD2, John P. Kress, MD3, and Ishaq Lat, PharmD4
Abstract Background: Atrial fibrillation (AF) has been extensively studied in postoperative critically ill surgical patients, but little literature exists to describe the outcomes of patients in the medical intensive care unit (ICU). Objectives: To determine the incidence of new-onset AF in patients admitted to a medical ICU and if new-onset AF was associated with adverse clinical outcomes. Methods: This was a single-center, retrospective study of all adult patients admitted to the medical ICU at an academic medical center for >24 hours between December 2008 and April 2010. Collected data included past medical history, incidence of new-onset AF, Acute Physiology and Chronic Health Evaluation II scores, organ failure, length of stay in the ICU and hospital, and in-hospital and 60-day survival. Results: A total of 741 patients were included. Newonset AF occurred in 53 patients (7.2%). In-hospital mortality was significantly greater for patients with new-onset AF (45% vs 16%; adjusted odds ratio [OR] = 2.21, 95% CI 1.07-4.54, P = 0.032), as was 60-day mortality (51% vs 23%; adjusted OR = 1.99, 95% CI = 1.01-3.91, P = 0.047). Patients with new-onset AF experienced greater ICU (6 ± 10.2 days vs 3 ± 3.6 days, P < 0.01) and hospital (15 ± 19 days vs 7 ± 9 days, P < 0.01) lengths of stay. Conclusions: Medical ICU patients who developed new-onset AF experienced a 2-fold increase in the odds of in-hospital mortality and death at 60 days. Further research investigating contributing factors to new-onset AF and potential treatments is warranted. Keywords arrhythmias, critical care, sepsis, epidemiology, clinical research
Introduction Of dysrhythmias in the intensive care unit (ICU), atrial fibrillation (AF) is among the most prevalent.1,2 Reported risk factors for developing AF in the intensive care setting include older age, male sex, history of arrhythmias, electrolyte abnormalities, volume overload, use of inotropes, cardiac surgery, mechanical ventilation for more than 24 hours, congestive heart failure, and hypertension.3,4 Critically ill patients may be particularly susceptible to new-onset AF because of baseline comorbidities; acute metabolic, ischemic, or neurohormonal stressors; or other pathophysiological changes during acute illness.5-9 Studies have reported the association of new-onset arrhythmias with greater morbidity, higher in-hospital mortality, longer ICU length of stay (LOS), and increased hospital LOS.1,2,5-10 Patients with severe sepsis and new-onset AF are more likely to experience in-hospital stroke and death compared with septic patients without new-onset AF.11 Although several studies have documented the association between new-onset AF and adverse outcomes, the literature describing the outcomes beyond intensive care is sparse. The aim of our study was to assess the incidence of
new-onset AF in patients admitted to a medical ICU, evaluate clinical outcomes with respect to mortality and LOS, and determine if new-onset AF is an independent risk factor for in-hospital and 60-day mortality in a population of medical ICU patients.
Materials and Methods Methods This single-center, retrospective, observational study was conducted at the University of Chicago Medical Center and evaluated medical ICU patients in chronological order between December 1, 2008, and April 1, 2010, admitted for 1
Cleveland Clinic Foundation, Cleveland, OH, USA The University of Chicago Medicine, Chicago, IL, USA 3 University of Chicago, Chicago, IL, USA 4 Rush University Medical Center, Chicago, IL, USA 2
Corresponding Author: Ishaq Lat, Department of Pharmacy, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA. Email: [email protected]
524 >24 hours. The exclusion criteria were as follows: age
research-article2015
AOPXXX10.1177/1060028015574726Annals of PharmacotherapyChen et al
Research Report
New-Onset Atrial Fibrillation Is an Independent Predictor of Mortality in Medical Intensive Care Unit Patients
Annals of Pharmacotherapy 2015, Vol. 49(5) 523–527 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028015574726 aop.sagepub.com
Alyssa Y. Chen, PharmD1, Sarah S. Sokol, PharmD2, John P. Kress, MD3, and Ishaq Lat, PharmD4
Abstract Background: Atrial fibrillation (AF) has been extensively studied in postoperative critically ill surgical patients, but little literature exists to describe the outcomes of patients in the medical intensive care unit (ICU). Objectives: To determine the incidence of new-onset AF in patients admitted to a medical ICU and if new-onset AF was associated with adverse clinical outcomes. Methods: This was a single-center, retrospective study of all adult patients admitted to the medical ICU at an academic medical center for >24 hours between December 2008 and April 2010. Collected data included past medical history, incidence of new-onset AF, Acute Physiology and Chronic Health Evaluation II scores, organ failure, length of stay in the ICU and hospital, and in-hospital and 60-day survival. Results: A total of 741 patients were included. Newonset AF occurred in 53 patients (7.2%). In-hospital mortality was significantly greater for patients with new-onset AF (45% vs 16%; adjusted odds ratio [OR] = 2.21, 95% CI 1.07-4.54, P = 0.032), as was 60-day mortality (51% vs 23%; adjusted OR = 1.99, 95% CI = 1.01-3.91, P = 0.047). Patients with new-onset AF experienced greater ICU (6 ± 10.2 days vs 3 ± 3.6 days, P < 0.01) and hospital (15 ± 19 days vs 7 ± 9 days, P < 0.01) lengths of stay. Conclusions: Medical ICU patients who developed new-onset AF experienced a 2-fold increase in the odds of in-hospital mortality and death at 60 days. Further research investigating contributing factors to new-onset AF and potential treatments is warranted. Keywords arrhythmias, critical care, sepsis, epidemiology, clinical research
Introduction Of dysrhythmias in the intensive care unit (ICU), atrial fibrillation (AF) is among the most prevalent.1,2 Reported risk factors for developing AF in the intensive care setting include older age, male sex, history of arrhythmias, electrolyte abnormalities, volume overload, use of inotropes, cardiac surgery, mechanical ventilation for more than 24 hours, congestive heart failure, and hypertension.3,4 Critically ill patients may be particularly susceptible to new-onset AF because of baseline comorbidities; acute metabolic, ischemic, or neurohormonal stressors; or other pathophysiological changes during acute illness.5-9 Studies have reported the association of new-onset arrhythmias with greater morbidity, higher in-hospital mortality, longer ICU length of stay (LOS), and increased hospital LOS.1,2,5-10 Patients with severe sepsis and new-onset AF are more likely to experience in-hospital stroke and death compared with septic patients without new-onset AF.11 Although several studies have documented the association between new-onset AF and adverse outcomes, the literature describing the outcomes beyond intensive care is sparse. The aim of our study was to assess the incidence of
new-onset AF in patients admitted to a medical ICU, evaluate clinical outcomes with respect to mortality and LOS, and determine if new-onset AF is an independent risk factor for in-hospital and 60-day mortality in a population of medical ICU patients.
Materials and Methods Methods This single-center, retrospective, observational study was conducted at the University of Chicago Medical Center and evaluated medical ICU patients in chronological order between December 1, 2008, and April 1, 2010, admitted for 1
Cleveland Clinic Foundation, Cleveland, OH, USA The University of Chicago Medicine, Chicago, IL, USA 3 University of Chicago, Chicago, IL, USA 4 Rush University Medical Center, Chicago, IL, USA 2
Corresponding Author: Ishaq Lat, Department of Pharmacy, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA. Email: [email protected]
524 >24 hours. The exclusion criteria were as follows: age
