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Postoperative Atrial Fibrillation and Heart Failure Hospitalization Risk
Quick Takes
- Incident postoperative atrial fibrillation (POAF) was associated with an increased risk for incident heart failure (HF) hospitalization among patients undergoing both cardiac and noncardiac surgeries.
- POAF may in some cases be a manifestation of preclinical HF and clinicians should be aware that POAF may be a harbinger of HF.
- Additional studies are indicated to examine the disease trajectory and mortality of those who develop POAF and whether implementing intensified preventive strategies among patients who develop POAF can prevent future HF.
Study Questions:
What is the association between postoperative atrial fibrillation (POAF) and incident heart failure (HF) hospitalization among patients undergoing cardiac and noncardiac surgeries?
Methods:
The investigators conducted a retrospective cohort study using all-payer administrative claims data that included all nonfederal emergency department visits and acute care hospitalizations across 11 states in the United States. The study population included adults aged ≥18 years hospitalized for surgery without a prior diagnosis of HF. Cox proportional hazards regression models were used to examine the association between POAF and incident HF hospitalization after making adjustment for socio-demographics and comorbid conditions.
Results:
Among 76,536 patients who underwent cardiac surgery, 14,365 (18.8%) developed incident POAF. In an adjusted Cox model, POAF was associated with incident HF hospitalization (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.25-1.41). In a sensitivity analysis excluding HF within 1 year of surgery, POAF remained associated with incident HF hospitalization (HR, 1.15; 95% CI, 1.01-1.31). Among 2,929,854 patients who underwent noncardiac surgery, 23,763 (0.8%) developed incident POAF. In an adjusted Cox model, POAF was again associated with incident HF hospitalization (HR, 2.02; 95% CI, 1.94-2.10), including in a sensitivity analysis excluding HF within 1 year of surgery (HR, 1.49; 95% CI, 1.38-1.61).
Conclusions:
The authors reported that POAF is associated with incident HF hospitalization among patients without prior history of HF undergoing both cardiac and noncardiac surgeries.
Perspective:
This study found that incident POAF was associated with an increased risk for incident HF hospitalization among patients undergoing both cardiac and noncardiac surgeries. These data suggest that POAF, often considered to be a transient response to surgery, may in some cases be a manifestation of preclinical HF and clinicians should be aware that POAF may be a harbinger of HF. Additional studies are indicated to examine the disease trajectory and mortality of those who develop POAF and whether implementing intensified preventive strategies among patients who develop POAF can prevent future HF and reduce its associated costs, morbidity, and mortality.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Cardiac Surgical Procedures, Emergency Service, Hospital, General Surgery, Heart Failure, Hospitalization, Morbidity, Postoperative Period, Risk, Secondary Prevention
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