Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study

Kyu Kim, Pil Sung Yang, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, Jung Hoon Sung, Hui Nam Pak, Moon Hyoung Lee, Gregory Y.H. Lip, Boyoung Joung

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)518-528
Number of pages11
JournalChest
Volume156
Issue number3
DOIs
Publication statusPublished - 2019 Sep

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Critical Care
Atrial Fibrillation
Cohort Studies
Embolism
Stroke
Mortality
National Health Programs
Recurrence
Propensity Score
Thromboembolism

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Kyu ; Yang, Pil Sung ; Jang, Eunsun ; Yu, Hee Tae ; Kim, Tae Hoon ; Uhm, Jae Sun ; Kim, Jong Youn ; Sung, Jung Hoon ; Pak, Hui Nam ; Lee, Moon Hyoung ; Lip, Gregory Y.H. ; Joung, Boyoung. / Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care : A South Korean Nationwide Cohort Study. In: Chest. 2019 ; Vol. 156, No. 3. pp. 518-528.
@article{43e916bb2fa44d54bcaabeb0fe98cb33,
title = "Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study",
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.",
author = "Kyu Kim and Yang, {Pil Sung} and Eunsun Jang and Yu, {Hee Tae} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Kim, {Jong Youn} and Sung, {Jung Hoon} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Lip, {Gregory Y.H.} and Boyoung Joung",
year = "2019",
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Kim, K, Yang, PS, Jang, E, Yu, HT, Kim, TH, Uhm, JS, Kim, JY, Sung, JH, Pak, HN, Lee, MH, Lip, GYH & Joung, B 2019, 'Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study', Chest, vol. 156, no. 3, pp. 518-528. https://doi.org/10.1016/j.chest.2019.04.011

Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care : A South Korean Nationwide Cohort Study. / Kim, Kyu; Yang, Pil Sung; Jang, Eunsun; Yu, Hee Tae; Kim, Tae Hoon; Uhm, Jae Sun; Kim, Jong Youn; Sung, Jung Hoon; Pak, Hui Nam; Lee, Moon Hyoung; Lip, Gregory Y.H.; Joung, Boyoung.

In: Chest, Vol. 156, No. 3, 09.2019, p. 518-528.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care

T2 - A South Korean Nationwide Cohort Study

AU - Kim, Kyu

AU - Yang, Pil Sung

AU - Jang, Eunsun

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Kim, Jong Youn

AU - Sung, Jung Hoon

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Lip, Gregory Y.H.

AU - Joung, Boyoung

PY - 2019/9

Y1 - 2019/9

N2 - 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.

AB - 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.

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U2 - 10.1016/j.chest.2019.04.011

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