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 journalArticlepeer-review

7 Citations (Scopus)

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

Bibliographical note

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. 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].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

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