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New-onset atrial fibrillation in adult critically ill patients: a scoping review

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Abstract

Purpose

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.

Method

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.

Results

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).

Conclusions

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.

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Funding

MW’s salary is paid by the Research Council of Rigshospitalet.

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Authors and Affiliations

  1. Department of Intensive Care, 4131, Copenhagen University Hospital, Rigshospitalet, 2100, Copenhagen, Denmark

    Mik Wetterslev, Nicolai Haase, Anders Granholm, Anders Perner & Morten Hylander Møller

  2. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    Christian Hassager

  3. Population Health Research Institute, McMaster University, Hamilton, ON, Canada

    Emilie P. Belley-Cote & William F. McIntyre

  4. Department of Critical Care Medicine, Peking University People’s Hospital, Beijing, China

    Youzhong An & Jiawei Shen

  5. Research Institute, HCor-Hospital Do Coração, São Paulo, Brazil

    Alexandre Biasi Cavalcanti, Fernando G. Zampieri & Helio Penna Guimaraes

Authors
  1. Mik Wetterslev
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  2. Nicolai Haase
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  3. Christian Hassager
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  4. Emilie P. Belley-Cote
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  6. Youzhong An
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  7. Jiawei Shen
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  8. Alexandre Biasi Cavalcanti
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  9. Fernando G. Zampieri
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  10. Helio Penna Guimaraes
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  11. Anders Granholm
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  12. Anders Perner
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  13. Morten Hylander Møller
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Contributions

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.

Corresponding author

Correspondence to Mik Wetterslev.

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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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Wetterslev, M., Haase, N., Hassager, C. et al. New-onset atrial fibrillation in adult critically ill patients: a scoping review. Intensive Care Med 45, 928–938 (2019). https://doi.org/10.1007/s00134-019-05633-x

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  • DOI: https://doi.org/10.1007/s00134-019-05633-x

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