학술논문
Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study*
Document Type
Academic Journal
Author
Wetterslev, Mik; Hylander Møller, Morten; Granholm, Anders; Hassager, Christian; Haase, Nicolai; Lange, Theis; Myatra, Sheila N.; Hästbacka, Johanna; Arabi, Yaseen M.; Shen, Jiawei; Cronhjort, Maria; Lindqvist, Elin; Aneman, Anders; Young, Paul J.; Szczeklik, Wojciech; Siegemund, Martin; Koster, Thijs; Aslam, Tayyba Naz; Bestle, Morten H.; Girkov, Mia S.; Kalvit, Kushal; Mohanty, Rakesh; Mascarenhas, Joanne; Pattnaik, Manoranjan; Vergis, Sara; Haranath, Sai Praveen; Shah, Mehul; Joshi, Ziyokov; Wilkman, Erika; Reinikainen, Matti; Lehto, Pasi; Jalkanen, Ville; Pulkkinen, Anni; An, Youzhong; Wang, Guoxing; Huang, Lei; Huang, Bin; Liu, Wei; Gao, Hengbo; Dou, Lin; Li, Shuangling; Yang, Wanchun; Tegnell, Emily; Knight, Agnes; Czuczwar, Miroslaw; Czarnik, Tomasz; Perner, Anders; Al Humedi, Haifaa Ibrahim; Zellweger, Nuria; Nuciforo, Chiara; Deng, Yanjun; Luo, Hua; Yan, Miao; Engstrøm, Janus; Krag, Mette; Bestle, Frederik H; Poulsen, Lone M; Hildebrandt, Thomas; Sofie Andreasen, Anne; Tjelle Kristiansen, Klaus; Mohr, Thomas; Møller-Sørensen, Hasse; Møller, Kirsten; Gorade, Manoj; Gandhi, Bhavesh; Jha, Tanya; Tisekar, Owais; Kar, Aparjeet; Nimavat, Balkrishan; Lappi, Elina; Heinonen, Jonna; Pettilä, Leena; Iso-Ketola, Maria; Saario, Minttu; Suhonen, Tarja; Vaskelainen, Eija; Halonen, Elina; Rahikainen, Sari; Julkunen, Sonja; Salkio, Sinikka; Mäkinen, Sanna; Ristimäki, Sanna; Hartikainen, Juho; Inkinen, Nina; Tolmunen, Sinikka; Oras, Jonatan; Delaney, Kirsha; Navarra, Leanlove; Cruz, Raulle; Olatunji, Shaanti; Bombinska, Marta; Laake, Jon; Keus, Frederik; Eck, Ruben
Source
Critical Care Medicine. Sep 01, 2023 51(9):1124-1137
Subject
Language
English
ISSN
0090-3493
Abstract
OBJECTIVES:: To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN:: Multicenter, prospective, inception cohort study. SETTING:: Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS:: Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8–17.6), of which newly developed AF was 13.3% (11.5–15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16–23), magnesium 16% (13–20), potassium 15% (12–19), amiodarone 51% (47–55), beta-1 selective blockers 34% (30–38), calcium channel blockers 4% (2–6), digoxin 16% (12–19), and direct current cardioversion in 4% (2–6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95–1.99). CONCLUSIONS:: In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.