Atrial fibrillation in critically ill patients who received prolonged mechanical ventilation: a nationwide inpatient report
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Background/Aims: To evaluate temporal trends of atrial fibrillation (AF) prevalence in critically ill patients who received prolonged mechanical ventilation (MV) in the United States. Methods: We used the 2008 to 2014 National Inpatient Sample to compute the weighted prevalence of AF among hospitalized adult patients on prolonged MV. We used multivariable-adjusted models to evaluate the association of AF with clinical factors, in-hospital mortality, hospitalization cost, and length of stay (LOS). Results: We identified 2,578,165 patients who received prolonged MV (21.27% of AF patients). The prevalence of AF increased from 14.63% in 2008 to 24.43% in 2014 (p for trend < 0.0001). Amongst different phenotypes of critically ill patients, the prevalence of AF increased in patients with severe sepsis, asthma exacerbation, congestive heart failure exacerbation, acute stroke, and cardiac arrest. Older age, male sex, white race, medicare access, higher income, urban teaching hospital setting, and Western region were associated with a higher prevalence of AF. AF in critical illness was a risk factor for in-hospital death (odds ratio, 1.13; 95% confidence interval, 1.11 to 1.15), but in-hospital mortality in critically ill patients with AF decreased from 11.6% to 8.3%. AF was linked to prolonged LOS (2%, p < 0.0001) and high hospitalization cost (4%, p < 0.0001). LOS (–1%, p < 0.0001) and hospitalization cost (–4%, p < 0.0001) decreased yearly. Conclusions: The prevalence of comorbid AF is increasing, particularly in older patients. AF may lead to poorer prognosis, and high-quality intensive care is imperative for this population.
Abstract
Background/Aims: To evaluate temporal trends of atrial fibrillation (AF) prevalence in critically ill patients who received prolonged mechanical ventilation (MV) in the United States. Methods: We used the 2008 to 2014 National Inpatient Sample to compute the weighted prevalence of AF among hospitalized adult patients on prolonged MV. We used multivariable-adjusted models to evaluate the association of AF with clinical factors, in-hospital mortality, hospitalization cost, and length of stay (LOS). Results: We identified 2,578,165 patients who received prolonged MV (21.27% of AF patients). The prevalence of AF increased from 14.63% in 2008 to 24.43% in 2014 (p for trend < 0.0001). Amongst different phenotypes of critically ill patients, the prevalence of AF increased in patients with severe sepsis, asthma exacerbation, congestive heart failure exacerbation, acute stroke, and cardiac arrest. Older age, male sex, white race, medicare access, higher income, urban teaching hospital setting, and Western region were associated with a higher prevalence of AF. AF in critical illness was a risk factor for in-hospital death (odds ratio, 1.13; 95% confidence interval, 1.11 to 1.15), but in-hospital mortality in critically ill patients with AF decreased from 11.6% to 8.3%. AF was linked to prolonged LOS (2%, p < 0.0001) and high hospitalization cost (4%, p < 0.0001). LOS (–1%, p < 0.0001) and hospitalization cost (–4%, p < 0.0001) decreased yearly. Conclusions: The prevalence of comorbid AF is increasing, particularly in older patients. AF may lead to poorer prognosis, and high-quality intensive care is imperative for this population.
참고문헌 (49)
- Kirchhof P, "The future of atrial fibrillation management : integrated care and stratified therapy", Lancet, 390, pp.1873~1887 (2017)
- Go AS, "Prevalence of diagnosed atrial fibrillation in adults : national implications for rhythm management and stroke prevention : the AnTicoagulation and Risk Factors in Atrial Fibrillation(ATRIA)Study", JAMA, 285, pp.2370~2375 (2001)
- Yoshida T, "The impact of sustained new-onset atrial fibrillation on mortality and stroke incidence in critically ill patients : a retrospective cohort study", J Crit Care, 44, pp.267~272 (2018)
- Yoshida T, "Epidemiology, prevention, and treatment of new-onset atrial fibrillation in critically ill : a systematic review", J Intensive Care, 3, pp.19~ (2015)
- Arrigo M, "New-onset atrial fibrillation in critically ill patients and its association with mortality : a report from the FROG-ICU study", Int J Cardiol, 266, pp.95~99 (2018)
- Mitric G, "Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill", Crit Care, 20, pp.90~ (2016)
- Reinelt P, "Incidence and type of cardiac arrhythmias in critically ill patients : a single center experience in a medical-cardiological ICU", Intensive Care Med, 27, pp.1466~1473 (2001)
- Lip GYH, "Antithrombotic therapy for atrial fibrillation : chest guideline and expert panel report", Chest, 154, pp.1121~1201 (2018)
- January CT, "2019 AHA", ACC, ACC, pp.HRS guideline for the management of patients with atrial fibrillation : a report of the American College of Cardiology, American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons[DOI]
- Chean CS, "Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey", PeerJ, 5, pp.e3716~ (2017)
- "Overview of the National (Nationwide) Inpatient Sample (NIS)" (2019)[URL]
- Hill CE, "Continuous EEG is associated with favorable hospitalization outcomes for critically ill patients", Neurology, 92, pp.e9~e18 (2019)
- Ghaferi AA, "Hospital characteristics associated with failure to rescue from complications after pancreatectomy", J Am Coll Surg, 211, pp.325~330 (2010)
- Lieffers JR, "A comparison of Charlson and Elixhauser comorbidity measures to predict colorectal cancer survival using administrative health data", Cancer, 117, pp.1957~1965 (2011)
- Otite FO, "Increasing atrial fibrillation prevalence in acute ischemic stroke and TIA", Neurology, 87, pp.2034~2042 (2016)
- Kumar G, "Outcomes of morbidly obese patients receiving invasive mechanical ventilation : a nationwide analysis", Chest, 144, pp.48~54 (2013)
- Alonso A, "Incidence of atrial fibrillation in whites and African-Americans : the Atherosclerosis Risk in Communities(ARIC)study", Am Heart J, 158, pp.111~117 (2009)
- Chen AY, "New-onset atrial fibrillation is an independent predictor of mortality in medical intensive care unit patients", Ann Pharmacother, 49, pp.523~527 (2015)
- Seguin P, "Incidence and risk factors of atrial fibrillation in a surgical intensive care unit", Crit Care Med, 32, pp.722~726 (2004)
- Seguin P, "Atrial fibrillation in trauma patients requiring intensive care", Intensive Care Med, 32, pp.398~404 (2006)
- Meierhenrich R, "Incidence and prognostic impact of new-onset atrial fibrillation in patients with septic shock : a prospective observational study", Crit Care, 14, pp.R108~ (2010)
- Makrygiannis SS, "Incidence and predictors of new-onset atrial fibrillation in noncardiac intensive care unit patients", J Crit Care, 29, pp.697~ (2014)
- Seguin P, "Atrial fibrillation is not just an artefact in the ICU", Crit Care, 14, pp.182~ (2010)
- Shaver CM, "Atrial fibrillation is an independent predictor of mortality in critically Ill patients", Crit Care Med, 43, pp.2104~2111 (2015)
- Krijthe BP, "Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060", Eur Heart J, 34, pp.2746~2751 (2013)
- Schnabel RB, "50 Year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study : a cohort study", Lancet, 386, pp.154~162 (2015)
- Taggar JS, "Accuracy of methods for diagnosing atrial fibrillation using 12-lead ECG : a systematic review and meta-analysis", Int J Cardiol, 184, pp.175~183 (2015)
- Menke A, "Associations between trends in race", ethnicity, aging, and body mass index with diabetes prevalence in the United States : a series of cross-sectional studies, 2014, pp.161, 328~335
- Flegal KM, "Trends in obesity among adults in the United States, 2005 to 2014", JAMA, 315, pp.2284~2291 (2016)
- Menke A, "Prevalence of and trends in diabetes among adults in the United States, 1988-2012", JAMA, 314, pp.1021~1029 (2015)
- Kumar N, "Atrial fibrillation associated hospitalizations in patients with end-stage renal disease in the United States, 2003-2012", Heart Rhythm, 13, pp.2027~2033 (2016)
- Xiao X, "Prevalence of atrial fibrillation in hospital encounters with end-stage COPD on home oxygen : national trends in the United States", Chest, 155, pp.918~927 (2019)
- Crawford TC, "Cardiac arrhythmias : management of atrial fibrillation in the critically ill patient", Crit Care Clin, 23, pp.855~872 (2007)
- Makrygiannis SS, "New-onset atrial fibrillation and clinical outcome in non-cardiac intensive care unit patients", Aust Crit Care, 31, pp.274~277 (2018)
- Lin MP, "Hospital-level variation and predictors of admission after ED visits for atrial fibrillation : 2006 to 2011", Am J Emerg Med, 34, pp.2094~2100 (2016)
- Moss TJ, "New-onset atrial fibrillation in the critically Ill", Crit Care Med, 45, pp.790~797 (2017)
- Duby JJ, "Prevalence and course of atrial fibrillation in critically Ill trauma patients", J Intensive Care Med, 32, pp.140~145 (2017)
- Lip GY, "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach : the euro heart survey on atrial fibrillation", Chest, 137, pp.263~272 (2010)
- Gupta S, "Atrial fibrillation and mortality in critically Ill patients : a retrospective study", Am J Crit Care, 24, pp.336~341 (2015)
- Bosch NA, "Atrial fibrillation in the ICU", Chest, 154, pp.1424~1434 (2018)
- Walkey AJ, "Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis", JAMA, 306, pp.2248~2254 (2011)
- Sibley S, "New-onset atrial fibrillation in critically ill patients", Can Respir J, 22, pp.179~182 (2015)
- Morelli A, "Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock : a randomized clinical trial", JAMA, 310, pp.1683~1691 (2013)
- Rudiger A, "Suitability, efficacy, and safety of vernakalant for new onset atrial fibrillation in critically ill patients", Crit Care Res Pract, 2014, pp.826286~ (2014)
- Watson T, "Mechanisms of thrombogenesis in atrial fibrillation : Virchow’s triad revisited", Lancet, 373, pp.155~166 (2009)
- Klein Klouwenberg PM, "Incidence, predictors, and outcomes of new-onset atrial fibrillation in critically Ill patients with sepsis : a cohort study", Am J Respir Crit Care Med, 195, pp.205~211 (2017)
- Kerlin MP, "Validation of administrative definitions of invasive mechanical ventilation across 30 intensive care units", Am J Respir Crit Care Med, 194, pp.1548~1552 (2016)
- Lawthers AG, "Identification of in-hospital complications from claims data. Is it valid?", Med Care, 38, pp.785~795 (2000)
- Carrera P, "Epidemiology and outcome of new-onset atrial fibrillation in the medical intensive care unit", J Crit Care, 36, pp.102~106 (2016)