New-onset postoperative atrial fibrillation management and outcomes
the VISION Cardiac Surgery cohort.
In the prospective VISION Cardiac Surgery cohort (12,234 patients, 12 countries), new-onset postoperative atrial fibrillation (POAF) occurred in 31.8% within 30 days of cardiac surgery. Antithrombotic and antiarrhythmic management varied widely: 15.6% received anticoagulation alone, 54.3% antiplatelets alone, 24% both, and 49% amiodarone. At one year, clinical AF was detected in 6.9% of POAF patients versus 0.6% without (aHR 11.3), and all-cause mortality was higher (3.0% vs 1.7%; aHR 1.54). POAF after cardiac surgery is thus common and associated with both more AF and higher mortality in the first year.
Methods
VISION Cardiac Surgery was a prospective cohort of adults who underwent cardiac surgery in 12 countries. The association of POAF with outcomes occurring between 30 days and 1 year postoperatively was estimated using a multivariable Cox model adjusted for patient and operative characteristics and for antithrombotic therapies.
Results
Among 12 234 patients (55.3% isolated coronary artery bypass grafting), 31.8% had POAF within 30 days of surgery. The proportion of participants with POAF who received anticoagulation alone at hospital discharge was 15.6%, 54.3% received antiplatelets alone, 23.9% received anticoagulation and antiplatelets, and 6.3% received neither; 48.8% were receiving amiodarone. At 1 year, clinical AF was detected in 6.9% of patients with POAF compared to 0.6% in those without [adjusted hazard ratio (aHR), 11.30; 95% confidence interval (CI) 8.17-15.70]. The primary composite outcome of stroke or vascular death occurred in 2.3% of patients with POAF and 1.5% in those without POAF (aHR 1.32; 95% CI 0.99-1.77). Patients with POAF had a higher risk of all-cause death (3.0% vs 1.7%; aHR 1.54; 95% CI 1.18-2.00).
Conclusions
New-onset POAF occurs in a third of patients after cardiac surgery; its antithrombotic and antiarrhythmic management varies. Patients with POAF have increased risks of both clinical AF and of all-cause death in the year following surgery.
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