Abstract
Background: The long-term risks of thromboembolism and mortality are unknown in patients who survived following atrial fibrillation (AF) newly diagnosed during critical care. Methods: Using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for > 6 months following AF newly diagnosed during critical care (ICU-AF), 269,751 control subjects with non-ICU AF (AF-control), and 439,868 control subjects without AF (No-AF) from 2005 to 2013. We performed propensity score matching and compared the risks of stroke/systemic embolism and all-cause mortality. Results: The adjusted hazard ratios (HRs) for long-term stroke/systemic embolism in the patients with ICU-AF were 0.93 (95% CI, 0.88-0.98) compared with the AF-control group and 1.50 (95% CI, 1.42-1.60) compared with the No-AF group. The adjusted HRs of the ICU-AF group for long-term mortality were 1.73 (95% CI, 1.70-1.83) and 3.20 (95% CI, 3.08-3.33) compared with the AF-control and No-AF groups, respectively. The risks of stroke/systemic embolism and mortality were significantly higher in the ICU-AF group than in the No-AF group after excluding patients with AF recurrence (adjusted HR, 1.08; 95% CI, 1.01-1.17), regardless of the causes of critical care and cardiovascular or noncardiovascular surgery. Conclusions: The patients who survived following AF newly diagnosed during critical care remained at a higher risk of long-term stroke/systemic embolism and mortality than the patients without AF regardless of AF recurrence and the causes of critical care. Close follow-up and continuous anticoagulation might be needed for these patients.
Original language | English |
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Pages (from-to) | 518-528 |
Number of pages | 11 |
Journal | Chest |
Volume | 156 |
Issue number | 3 |
DOIs | |
Publication status | Published - 2019 Sep |
Bibliographical note
Funding Information:FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].
Funding Information:
FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education , Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].
Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer /Janssen, BMS / Pfizer , Biotronik , Medtronic , Boehringer Ingelheim , Novartis , Verseon, and Daiichi-Sankyo , and as a speaker for Bayer , BMS / Pfizer , Medtronic , Boehringer Ingelheim , and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer , BMS / Pfizer , Medtronic , and Daiichi-Sankyo , and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K., P.-S. Y., E. J., H. T. Y., T.-H. K., J.-S. U., J.-Y. K., J.-H. S., H.-N. P., M.-H. L.).
Funding Information:
FUNDING/SUPPORT: This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology [NRF-2017R1A2B3003303] and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare [HI16C0058 and HI15C1200].Author contributions: K. K. and P.-S. Y contributed to data collection, data interpretation, figure creation, and writing of the manuscript. E. J. contributed to data collection. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. contributed to data collection and literature search. H.-N. P. and M.-H. L. contributed with advice and provided critical revisions to the manuscript. G. Y. H. L. and B. J. contributed to study design and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; no fees were directly received personally. B. J. has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo, and has received research funding from Medtronic and Abbott; no fees were directly received personally. None declared (K. K. P.-S. Y. E. J. H. T. Y. T.-H. K. J.-S. U. J.-Y. K. J.-H. S. H.-N. P. M.-H. L.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Additional information: The e-Figure, e-Appendix 1, and e-Tables can be found in the Supplemental Materials section of the online article.
Publisher Copyright:
© 2019 American College of Chest Physicians
All Science Journal Classification (ASJC) codes
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine