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Title: | Predictors of acute hospital mortality and length of stay in patients with new-onset atrial fibrillation: a first-hand experience from a medical emergency team response provider. | Authors: | Crozier T.M.;Nasis A. ;Mirzaee S.;Tan S.X.;Junckerstorff R.;Thein P.M. ;Ong J. | Institution: | (Thein, Ong, Tan, Junckerstorff) Department of General Medicine, Monash Medical Centre, Melbourne, VIC, Australia (Thein, Nasis, Mirzaee) MonashHeart, Monash Cardiovascular Research Centre, Monash University, Monash Health, Melbourne, VIC, Australia (Crozier) Department of Intensive Care, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia | Issue Date: | 14-Aug-2019 | Copyright year: | 2019 | Publisher: | Blackwell Publishing | Place of publication: | Australia | Publication information: | Internal Medicine Journal. 49 (8) (pp 969-977), 2019. Date of Publication: 2019. | Journal: | Internal Medicine Journal | Abstract: | Background: Atrial fibrillation (AF) occurs frequently following cardiothoracic surgery and treatment decisions are informed by evidence-based clinical guidelines. Outside this setting there are few data to guide clinical management. Aim(s): To describe the characteristics, management and outcomes of hospitalised adult patients with new-onset AF. Method(s): The medical emergency team (MET) database was utilised to identify patients who had a 'MET call' activated for tachycardia between 2015 and 2016. Patients with sinus tachycardia, pre-existing AF/atrial flutter or other known tachyarrhythmia were excluded. Primary outcomes were length of hospital stay and in-hospital mortality. Result(s): New-onset AF was identified in 137 patients: 68 medically managed; 38 non-cardiothoracic post-operative; and 31 cardiothoracic post-operative. Mean age was 74 +/- 11.6 years and 72 (53%) were male. Of 79 patients who underwent echocardiography, 80% had left atrial dilatation and 14% had reduced left ventricular ejection fraction (LVEF). Mean length of stay (LOS) was 12 days and in-hospital mortality rate was 11%. On multivariable analysis, the odds of death during acute hospitalisation was 7.4 times higher in patients with heart failure with reduced LVEF (odds ratio 7.4, 95% confidence interval (CI) 1.23-44.8, P = 0.028). Length of acute hospital stay increased by 36% if the duration of AF was longer than 48 h (beta coefficient 0.36, 95% CI -0.015 to 0.74, P = 0.059). Conclusion(s): Left ventricular systolic dysfunction in hospitalised patients with new-onset AF is associated with increased all-cause mortality whereas lower serum potassium levels are associated with an increased LOS. A prospective study is planned to compare outcomes based on in-hospital treatment strategies.Copyright © 2019 Royal Australasian College of Physicians | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1111/imj.14236 | PubMed URL: | 30693656 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30693656] | ISSN: | 1444-0903 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35637 | Type: | Article | Subjects: | patient identification potassium/ec [Endogenous Compound] work experience treatment outcome thorax surgery sinus tachycardia rapid response team priority journal *predictor variable potassium blood level postoperative period aged all cause mortality article *atrial fibrillation cohort analysis controlled study disease association disease duration echocardiography female health care management heart failure with reduced ejection fraction heart left ventricle ejection fraction *hospital mortality hospitalization human left ventricular systolic dysfunction *length of stay major clinical study male mortality rate observational study disease duration echocardiography female observational study patient identification postoperative period potassium blood level *predictor variable priority journal rapid response team sinus tachycardia thorax surgery treatment outcome work experience human *hospital mortality aged all cause mortality Article *atrial fibrillation cohort analysis controlled study disease association health care management male major clinical study *length of stay left ventricular systolic dysfunction mortality rate hospitalization heart left ventricle ejection fraction heart failure with reduced ejection fraction |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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