New-onset atrial fibrillation in adult critically ill patients: a scoping review
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New-onset atrial fibrillation (NOAF) is common and associated with increased morbidity and mortality. However, its clinical importance and management in critically ill patients are not well described. The aim of this scoping review is to assess the epidemiology and management strategies of NOAF during critical illness.
The review was conducted in accordance with the PRISMA extension for scoping reviews. We searched PubMed, EMBASE and the Cochrane Library for studies assessing the incidence, outcome and management strategies of NOAF in adult critically ill patients. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
A total of 99 studies were included, of which 79 were observational and 20 were interventional. The incidence of NOAF varied from 1.7% to 43.9% with considerable inter-population variation (very low quality of evidence). Commonly identified risk factors for NOAF included higher age, cardiovascular comorbidities and sepsis. The occurrence of NOAF was associated with adverse outcomes, including stroke, prolonged length of stay and mortality (very low quality of evidence). We found limited data on the optimal management strategy with no evidence for firm benefit or harm for any intervention (very low/low quality of evidence).
The definition and incidence of NOAF in critically ill patients varied considerably and many risk factors were identified. NOAF seemed to be associated with adverse outcomes, but data were very limited and current management strategies are not evidence-based.
KeywordsAtrial fibrillation Arrhythmias Cardiac Tachycardia Critical illness Intensive care units Risk factors Stroke Thromboembolism Mortality Review
MW, NH, AP and MHM contributed to the study design. MW and NH contributed to the study selection. MW performed the data extraction. All the authors contributed to the revision of the manuscript.
MW’s salary is paid by the Research Council of Rigshospitalet.
Compliance with ethical standards
Conflicts of interest
The authors have received no specific funding for this study. The Department of Intensive Care at Rigshospitalet receives support for other research projects from Ferring Pharmaceuticals, Denmark; and the Novo Nordisk Foundation, Denmark.
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