Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study. Wetterslev, M., Hylander Møller, M., Granholm, A., Hassager, C., Haase, N., Lange, T., Myatra, S. N., Hästbacka, J., Arabi, Y. M., Shen, J., Cronhjort, M., Lindqvist, E., Aneman, A., Young, P. J., Szczeklik, W., Siegemund, M., Koster, T., Aslam, T. N., Bestle, M. H., Girkov, M. S., Kalvit, K., Mohanty, R., Mascarenhas, J., Pattnaik, M., Vergis, S., Haranath, S. P., Shah, M., Joshi, Z., Wilkman, E., Reinikainen, M., Lehto, P., Jalkanen, V., Pulkkinen, A., An, Y., Wang, G., Huang, L., Huang, B., Liu, W., Gao, H., Dou, L., Li, S., Yang, W., Tegnell, E., Knight, A., Czuczwar, M., Czarnik, T., Perner, A., & AFIB-ICU Collaborators Critical Care Medicine, 51(9):1124–1137, September, 2023.
doi  abstract   bibtex   
OBJECTIVES: To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN: Multicenter, prospective, inception cohort study. SETTING: Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS: Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99). CONCLUSIONS: In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.
@article{wetterslev_atrial_2023,
	title = {Atrial {Fibrillation} ({AFIB}) in the {ICU}: {Incidence}, {Risk} {Factors}, and {Outcomes}: {The} {International} {AFIB}-{ICU} {Cohort} {Study}},
	volume = {51},
	issn = {1530-0293},
	shorttitle = {Atrial {Fibrillation} ({AFIB}) in the {ICU}},
	doi = {10.1097/CCM.0000000000005883},
	abstract = {OBJECTIVES: To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF.
DESIGN: Multicenter, prospective, inception cohort study.
SETTING: Forty-four ICUs in 12 countries in four geographical regions.
SUBJECTS: Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: We included 1,423 ICU patients and analyzed 1,415 (99.4\%), among whom 221 patients had 539 episodes of AF. Most (59\%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6\% (95\% CI, 13.8-17.6), of which newly developed AF was 13.3\% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19\% (95\% CI 16-23), magnesium 16\% (13-20), potassium 15\% (12-19), amiodarone 51\% (47-55), beta-1 selective blockers 34\% (30-38), calcium channel blockers 4\% (2-6), digoxin 16\% (12-19), and direct current cardioversion in 4\% (2-6). Patients with AF had more ischemic, thromboembolic (13.6\% vs 7.9\%), and severe bleeding events (5.9\% vs 2.1\%), and higher mortality (41.2\% vs 25.2\%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95\% CI, 0.95-1.99).
CONCLUSIONS: In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.},
	language = {eng},
	number = {9},
	journal = {Critical Care Medicine},
	author = {Wetterslev, Mik and Hylander Møller, Morten and Granholm, Anders and Hassager, Christian and Haase, Nicolai and Lange, Theis and Myatra, Sheila N. and Hästbacka, Johanna and Arabi, Yaseen M. and Shen, Jiawei and Cronhjort, Maria and Lindqvist, Elin and Aneman, Anders and Young, Paul J. and Szczeklik, Wojciech and Siegemund, Martin and Koster, Thijs and Aslam, Tayyba Naz and Bestle, Morten H. and Girkov, Mia S. and Kalvit, Kushal and Mohanty, Rakesh and Mascarenhas, Joanne and Pattnaik, Manoranjan and Vergis, Sara and Haranath, Sai Praveen and Shah, Mehul and Joshi, Ziyokov and Wilkman, Erika and Reinikainen, Matti and Lehto, Pasi and Jalkanen, Ville and Pulkkinen, Anni and An, Youzhong and Wang, Guoxing and Huang, Lei and Huang, Bin and Liu, Wei and Gao, Hengbo and Dou, Lin and Li, Shuangling and Yang, Wanchun and Tegnell, Emily and Knight, Agnes and Czuczwar, Miroslaw and Czarnik, Tomasz and Perner, Anders and {AFIB-ICU Collaborators}},
	month = sep,
	year = {2023},
	pmid = {37078722},
	keywords = {Adult, Atrial Fibrillation, Cohort Studies, Humans, Incidence, Intensive Care Units, Prospective Studies, Risk Factors},
	pages = {1124--1137},
}
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