33% of patients with first AF event during noncardiac hospitalization had recurrent events
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Key takeaways:
- Risk for AF recurrence was increased in patients who experienced a first AF event during noncardiac hospitalization.
- Nearly one in three patients with transient new-onset AF had a recurrent event.
Patients hospitalized for a noncardiac reason with a first-time atrial fibrillation event in-hospital were more likely to have a recurrent event in the 12 months after discharge vs. matched controls with no prior AF, researchers reported.
“Atrial fibrillation occurring transiently with stress (AFOTS) refers to AF that is detected for the first time in patients who are hospitalized for another medical or surgical illness. The effect of AFOTS on patients’ long-term stroke risk is uncertain,” William F. McIntyre, MD, PhD, assistant professor of medicine, faculty of health sciences at McMaster University in Hamilton, Ontario, Canada, and colleagues wrote. “Several published studies have shown higher risk for AF recurrence and worse clinical outcomes in patients with AFOTS. However, the risk for AF recurrence in patients with transient new-onset AF that is concurrent with another illness has not been systematically assessed in a prospective study using continuous ECG monitors.”
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For this study, McIntyre and colleagues systematically screened ICUs, surgical wards and medical wards at three academic hospitals in Hamilton, Ontario, Canada, and identified 139 patients with AF detected during hospitalization for a noncardiac reason and no history of AF (mean age, 71 years; 59% men). All patients were age- and sex-matched to controls with no AF from the same hospital.
To detect AF recurrence, a 14-day ECG monitor was used at 1 and 6 months and telephone interviews were conducted at 1, 6 and 12 months after discharge in sinus rhythm. The primary outcome was AF lasting 30 seconds or more on the 14-day ECG monitor or captured by ECG 12-lead during routine care at 12 months.
After 1 year, recurrent AF was detected in 33.1% of patients with transient new-onset AF and in 5% of matched controls, according to the study.
McIntyre and colleagues estimated that after adjustment for the number of ECG monitors worn and baseline characteristics, the adjusted RR for recurrent AF among patients with transient new-onset AF was 6.6 (95% CI, 3.2-13.7).
When the researchers excluded 40 participants with transient new-onset AF who required electrical or pharmacologic cardioversion during index hospitalization and limited the study to AF events detected by the 14-day ECG monitor, recurrent AF was detected in 32.3% of participants with transient new-onset AF and 3% of their matched controls.
Compared with the lowest tertile, patients in the highest tertile of left atrial volume were at elevated risk for recurrent AF (adjusted RR = 3.9; 95% CI, 1.37-11.08), the researchers found.
“Our study found that among patients who have new-onset transient AF detected during a hospitalization for noncardiac surgery or medical illness and are discharged in sinus rhythm, approximately one in three have AF detected in the year after hospital discharge. This risk for AF recurrence was approximately seven times higher than in matched control participants,” the researchers wrote. “These results may mean that an important subset of patients with transient new-onset AF detected during a hospitalization for another reason have paroxysmal AF that can be detected through systematic clinical follow-up.”
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