Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study

Mik Wetterslev; Morten Hylander Møller; Anders Granholm; Christian Hassager; Nicolai Haase; Theis Lange; Sheila N Myatra; Johanna Hästbacka; Yaseen M Arabi; Jiawei Shen; Maria Cronhjort; Elin Lindqvist; Anders Aneman; Paul J Young; Wojciech Szczeklik; Martin Siegemund; Thijs Koster; Tayyba Naz Aslam; Morten H Bestle; Mia S Girkov; Kushal Kalvit; Rakesh Mohanty; Joanne Mascarenhas; Manoranjan Pattnaik; Sara Vergis; Sai Praveen Haranath; Mehul Shah; Ziyokov Joshi; Erika Wilkman; Matti Reinikainen; Pasi Lehto; Ville Jalkanen; Anni Pulkkinen; Youzhong An; Guoxing Wang; Lei Huang; Bin Huang; Wei Liu; Hengbo Gao; Lin Dou; Shuangling Li; Wanchun Yang; Emily Tegnell; Agnes Knight; Miroslaw Czuczwar; Tomasz Czarnik; Anders Perner; and the AFIB-ICU Collaborators; Frederik Bestle; Anne Sofie Andreasen; Klaus Tjelle Kristiansen; Thomas Mohr; Peter Hasse Møller-Sørensen; Kirsten Møller; AFIB-ICU collaborators; Janus Engstrøm

doi:10.1097/CCM.0000000000005883

Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study

Mik Wetterslev^*, Morten Hylander Møller, Anders Granholm, Christian Hassager, Nicolai Haase, Theis Lange, Sheila N Myatra, Johanna Hästbacka, Yaseen M Arabi, Jiawei Shen, Maria Cronhjort, Elin Lindqvist, Anders Aneman, Paul J Young, Wojciech Szczeklik, Martin Siegemund, Thijs Koster, Tayyba Naz Aslam, Morten H Bestle, Mia S GirkovKushal Kalvit, Rakesh Mohanty, Joanne Mascarenhas, Manoranjan Pattnaik, Sara Vergis, Sai Praveen Haranath, Mehul Shah, Ziyokov Joshi, Erika Wilkman, Matti Reinikainen, Pasi Lehto, Ville Jalkanen, Anni Pulkkinen, Youzhong An, Guoxing Wang, Lei Huang, Bin Huang, Wei Liu, Hengbo Gao, Lin Dou, Shuangling Li, Wanchun Yang, Emily Tegnell, Agnes Knight, Miroslaw Czuczwar, Tomasz Czarnik, Anders Perner, and the AFIB-ICU Collaborators, Frederik Bestle (Member of study group), Anne Sofie Andreasen (Member of study group), Klaus Tjelle Kristiansen (Member of study group), Thomas Mohr (Member of study group), Peter Hasse Møller-Sørensen (Member of study group), Kirsten Møller (Member of study group), AFIB-ICU collaborators, Janus Engstrøm (Member of study group)

^*Corresponding author for this work

9 Citations (Scopus)

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.

Original language	English
Journal	Critical Care Medicine
Volume	51
Issue number	9
Pages (from-to)	1124-1137
Number of pages	14
ISSN	0090-3493
DOIs	https://doi.org/10.1097/CCM.0000000000005883
Publication status	Published - 1 Sept 2023

Keywords

Adult
Atrial Fibrillation/epidemiology
Cohort Studies
Humans
Incidence
Intensive Care Units
Prospective Studies
Risk Factors
critical illness
intensive care units
adverse outcomes
management
newly developed atrial fibrillation

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10.1097/CCM.0000000000005883

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Wetterslev, M., Hylander Møller, M., Granholm, A., Hassager, C., Haase, N., Lange, T., Myatra, S. N., Hästbacka, J., Arabi, Y. M., Shen, J., Cronhjort, M., Lindqvist, E., Aneman, A., Young, P. J., Szczeklik, W., Siegemund, M., Koster, T., Aslam, T. N., Bestle, M. H., ... Engstrøm, J. (2023). Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study. Critical Care Medicine, 51(9), 1124-1137. https://doi.org/10.1097/CCM.0000000000005883

Wetterslev, M, Hylander Møller, M , Granholm, A , Hassager, C , Haase, N, Lange, T, Myatra, SN, Hästbacka, J, Arabi, YM, Shen, J, Cronhjort, M, Lindqvist, E, Aneman, A, Young, PJ, Szczeklik, W, Siegemund, M, Koster, T, Aslam, TN, Bestle, MH, Girkov, MS, Kalvit, K, Mohanty, R, Mascarenhas, J, Pattnaik, M, Vergis, S, Haranath, SP, Shah, M, Joshi, Z, Wilkman, E, Reinikainen, M, Lehto, P, Jalkanen, V, Pulkkinen, A, An, Y, Wang, G, Huang, L, Huang, B, Liu, W, Gao, H, Dou, L, Li, S, Yang, W, Tegnell, E, Knight, A, Czuczwar, M, Czarnik, T, Perner, A, and the AFIB-ICU Collaborators, Bestle, F, Andreasen, AS, Kristiansen, KT , Mohr, T , Møller-Sørensen, PH , Møller, K, AFIB-ICU collaborators & Engstrøm, J 2023, 'Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study', Critical Care Medicine, vol. 51, no. 9, pp. 1124-1137. https://doi.org/10.1097/CCM.0000000000005883

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title = "Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study",

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.",

keywords = "Adult, Atrial Fibrillation/epidemiology, Cohort Studies, Humans, Incidence, Intensive Care Units, Prospective Studies, Risk Factors, critical illness, intensive care units, adverse outcomes, management, newly developed atrial fibrillation",

author = "Mik Wetterslev and {Hylander M{\o}ller}, Morten and Anders Granholm and Christian Hassager and Nicolai Haase and Theis Lange and Myatra, {Sheila N} and Johanna H{\"a}stbacka and Arabi, {Yaseen M} and Jiawei Shen and Maria Cronhjort and Elin Lindqvist and Anders Aneman and Young, {Paul J} and Wojciech Szczeklik and Martin Siegemund and Thijs Koster and Aslam, {Tayyba Naz} and Bestle, {Morten H} and Girkov, {Mia S} and Kushal Kalvit and Rakesh Mohanty and Joanne Mascarenhas and Manoranjan Pattnaik and Sara Vergis and Haranath, {Sai Praveen} and Mehul Shah and Ziyokov Joshi and Erika Wilkman and Matti Reinikainen and Pasi Lehto and Ville Jalkanen and Anni Pulkkinen and Youzhong An and Guoxing Wang and Lei Huang and Bin Huang and Wei Liu and Hengbo Gao and Lin Dou and Shuangling Li and Wanchun Yang and Emily Tegnell and Agnes Knight and Miroslaw Czuczwar and Tomasz Czarnik and Anders Perner and {and the AFIB-ICU Collaborators} and Frederik Bestle and Andreasen, {Anne Sofie} and Kristiansen, {Klaus Tjelle} and Thomas Mohr and M{\o}ller-S{\o}rensen, {Peter Hasse} and Kirsten M{\o}ller and {AFIB-ICU collaborators} and Janus Engstr{\o}m",

year = "2023",

month = sep,

day = "1",

doi = "10.1097/CCM.0000000000005883",

language = "English",

volume = "51",

pages = "1124--1137",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "Lippincott Williams & Wilkins",

number = "9",

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TY - JOUR

T1 - Atrial Fibrillation (AFIB) in the ICU

T2 - Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study

AU - Wetterslev, Mik

AU - Hylander Møller, Morten

AU - Granholm, Anders

AU - Hassager, Christian

AU - Haase, Nicolai

AU - Lange, Theis

AU - Myatra, Sheila N

AU - Hästbacka, Johanna

AU - Arabi, Yaseen M

AU - Shen, Jiawei

AU - Cronhjort, Maria

AU - Lindqvist, Elin

AU - Aneman, Anders

AU - Young, Paul J

AU - Szczeklik, Wojciech

AU - Siegemund, Martin

AU - Koster, Thijs

AU - Aslam, Tayyba Naz

AU - Bestle, Morten H

AU - Girkov, Mia S

AU - Kalvit, Kushal

AU - Mohanty, Rakesh

AU - Mascarenhas, Joanne

AU - Pattnaik, Manoranjan

AU - Vergis, Sara

AU - Haranath, Sai Praveen

AU - Shah, Mehul

AU - Joshi, Ziyokov

AU - Wilkman, Erika

AU - Reinikainen, Matti

AU - Lehto, Pasi

AU - Jalkanen, Ville

AU - Pulkkinen, Anni

AU - An, Youzhong

AU - Wang, Guoxing

AU - Huang, Lei

AU - Huang, Bin

AU - Liu, Wei

AU - Gao, Hengbo

AU - Dou, Lin

AU - Li, Shuangling

AU - Yang, Wanchun

AU - Tegnell, Emily

AU - Knight, Agnes

AU - Czuczwar, Miroslaw

AU - Czarnik, Tomasz

AU - Perner, Anders

AU - and the AFIB-ICU Collaborators

AU - AFIB-ICU collaborators

A2 - Bestle, Frederik

A2 - Andreasen, Anne Sofie

A2 - Kristiansen, Klaus Tjelle

A2 - Mohr, Thomas

A2 - Møller-Sørensen, Peter Hasse

A2 - Møller, Kirsten

A2 - Engstrøm, Janus

PY - 2023/9/1

Y1 - 2023/9/1

N2 - 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.

AB - 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.

KW - Adult

KW - Atrial Fibrillation/epidemiology

KW - Cohort Studies

KW - Humans

KW - Incidence

KW - Intensive Care Units

KW - Prospective Studies

KW - Risk Factors

KW - critical illness

KW - intensive care units

KW - adverse outcomes

KW - management

KW - newly developed atrial fibrillation

UR - http://www.scopus.com/inward/record.url?scp=85160112433&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000005883

DO - 10.1097/CCM.0000000000005883

M3 - Journal article

C2 - 37078722

SN - 0090-3493

VL - 51

SP - 1124

EP - 1137

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 9

ER -

Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study

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