Atrial fibrillation (AF) is often detected for the first time in patients who are hospitalized for another reason. Management of patients whose AF resolves before discharge is not always clear. In this matched cohort study, the authors examined the risks for AF recurrence among patients with new AF who were hospitalized for another surgical or medical diagnosis and whose AF resolved before discharge.
Abstract
Background:
Atrial fibrillation (AF) is often detected for the first time in patients who are hospitalized for another reason. Long-term risks for AF recurrence in these patients are unclear.
Objective:
To estimate risk for AF recurrence in patients with new-onset AF during a hospitalization for noncardiac surgery or medical illness compared with a matched population without AF.
Design:
Matched cohort study. (ClinicalTrials.gov: NCT03221777)
Setting:
Three academic hospitals in Hamilton, Ontario, Canada.
Participants:
The study enrolled patients hospitalized for noncardiac surgery or medical illness who had transient new-onset AF. For each participant, an age- and sex-matched control participant with no history of AF from the same hospital ward was recruited. All participants left the hospital in sinus rhythm.
Measurements:
14-day electrocardiographic (ECG) monitor at 1 and 6 months and telephone assessment at 1, 6, and 12 months. The primary outcome was AF lasting at least 30 seconds on the monitor or captured by ECG 12-lead during routine care at 12 months.
Results:
Among 139 participants with transient new-onset AF (70 patients with medical illness and 69 surgical patients) and 139 matched control participants, the mean age was 71 years (SD, 10), the mean CHA2DS2-VASc score was 3.0 (SD, 1.5), and 59% were male. The median duration of AF during the index hospitalization was 15.8 hours (IQR, 6.4 to 49.6 hours). After 1 year, recurrent AF was detected in 33.1% (95% CI, 25.3% to 40.9%) of participants in the transient new-onset AF group and 5.0% (CI, 1.4% to 8.7%) of matched control participants; after adjustment for the number of ECG monitors worn and for baseline clinical differences, the adjusted relative risk was 6.6 (CI, 3.2 to 13.7). After exclusion of participants who had electrical or pharmacologic cardioversion during the index hospitalization (n = 40) and their matched control participants and limiting to AF events detected by the patch ECG monitor, recurrent AF was detected in 32.3% (CI, 23.1% to 41.5%) of participants with transient new-onset AF and 3.0% (CI, 0% to 6.4%) of matched control participants.
Limitations:
Generalizability is limited, and the study was underpowered to evaluate subgroups and clinical predictors.
Conclusion:
Among patients who have transient new-onset AF during a hospitalization for noncardiac surgery or medical illness, approximately 1 in 3 will have recurrent AF within 1 year.
Primary Funding Source:
Peer-reviewed grants.
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Author, Article, and Disclosure Information
William F. McIntyre,
Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; and Population Health Research Institute, Hamilton, Ontario, Canada (W.F.M., S.J.C., D.C., J.A.W., P.J.D., J.S.H.)
Population Health Research Institute, Hamilton, Ontario, Canada (M.E.V., A.S.R., N.R.L., A.J.G., C.R.)
Department of Health Research Methods, Evidence, and Impact, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (P.A.M.)
Population Health Research Institute, and Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (A.P.L.)
Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (J.G.A.)
Division of Cardiology, Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada (K.J.U., J.D.R.)
Division of Cardiology, Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University; Population Health Research Institute; and Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (E.P.B.)
Department of Health Research Methods, Evidence, and Impact, McMaster University; Population Health Research Institute; Michael G. DeGroote School of Medicine, McMaster University; Division of Critical Care, Department of Medicine, McMaster University; and Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada (R.P.W.).
Financial Support: This study was funded by peer-reviewed research grants from the Canadian Cardiovascular Society (CCS) Bayer Resident Vascular Award, the CCS Atrial Fibrillation Awards, the Heart and Stroke Foundation of Canada, and the Canadian Stroke Prevention Intervention Network (C-SPIN). Dr. McIntyre received peer-reviewed salary awards to work on this study from C-SPIN, the Canadian Institutes of Health Research, and the McMaster Cooper Foundation.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-1411.
Reproducible Research Statement: Study protocol: The previously published design and rationale paper is available in reference 19. Statistical code: Available from Dr. McIntyre (e-mail, William.
Corresponding Author: William F. McIntyre, MD, PhD, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada; e-mail, William.
Author Contributions: Conception and design: W.F. McIntyre, S.J. Connolly, E.P. Belley-Côté, R.P. Whitlock, J.S. Healey.
Analysis and interpretation of the data: W.F. McIntyre, A.J. Grinvalds, C. Ramasundarahettige, J.D. Roberts, D. Conen, J.A. Wong, E.P. Belley-Côté, R.P. Whitlock, J.S. Healey.
Drafting of the article: W.F. McIntyre, C. Ramasundarahettige, K.J. Um, J.A. Wong, R.P. Whitlock.
Critical revision for important intellectual content: W.F. McIntyre, J.D. Roberts, D. Conen, J.A. Wong, P.J. Devereaux, E.P. Belley-Côté, R.P. Whitlock, J.S. Healey.
Final approval of the article: W.F. McIntyre, M.E. Vadakken, S.J. Connolly, P.A. Mendoza, A.P. Lengyel, A.S. Rai, N.R. Latendresse, A.J. Grinvalds, C. Ramasundarahettige, J.G. Acosta, K.J. Um, J.D. Roberts, D. Conen, J.A. Wong, P.J. Devereaux, E.P. Belley-Côté, R.P. Whitlock, J.S. Healey.
Provision of study materials or patients: W.F. McIntyre, K.J. Um, J.A. Wong.
Statistical expertise: S.J. Connolly, C. Ramasundarahettige.
Obtaining of funding: W.F. McIntyre, J.S. Healey.
Administrative, technical, or logistic support: W.F. McIntyre, M.E. Vadakken, P.A. Mendoza, A.S. Rai, N.R. Latendresse, A.J. Grinvalds, J.G. Acosta, K.J. Um, J.A. Wong, J.S. Healey.
Collection and assembly of data: W.F. McIntyre, M.E. Vadakken, P.A. Mendoza, A.P. Lengyel, A.S. Rai, N.R. Latendresse, A.J. Grinvalds, J.G. Acosta, K.J. Um, R.P. Whitlock, J.S. Healey.
This article was published at Annals.org on 3 October 2023.
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