New-Onset Atrial Fibrillation and Associated Outcomes and Resource Utilization Among Critically Ill Adults
CCCF ePoster library. Fernando S. 11/13/19; 283398; EP112
Dr. Shannon Fernando
Dr. Shannon Fernando
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Fernando, Shannon M., MD, MSc1,2; Mathew, Rebecca, MD1,3; Hibbert, Benjamin, MD, PhD3; Rochwerg, Bram, MD, MSc4,5; Munshi, Laveena, MD, MSc6,7; Walkey, Allan J., MD, MSc8,9; Møller, Morten Hylander, MD, PhD10; Simard, Trevor, MD3; Di Santo, Pietro, MD3; Ramirez, F. Daniel, MD3; Tanuseputro, Peter, MD, MHSc11, 12,13; Kyeremanteng, Kwadwo, MD, MHA1,11,13
 

  1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON.
  2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON.
  3. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON.
  4. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON.
  5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON.
  6. Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON.
  7. Department of Medicine, Sinai Health System, Toronto, ON.
  8. Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, MA.
  9. Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA.
  10. Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark.
  11. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.  
  12. Bruyere Research Institute, Ottawa, ON.
  13. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON.

INTRODUCTION: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence surrounding the association between NOAF and outcomes of critically ill patients is conflicting. Furthermore, little is known regarding the association between NOAF and resource utilization and hospital costs.   
 
OBJECTIVES: We sought to evaluate the association between NOAF and outcomes and costs of adult ICU patients. 
 
METHODS: We performed a retrospective analysis (2011-2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age. Atrial fibrillation (AF) detection was prospectively recorded by bedside nurses. NOAF was defined as either: 1) The observation of AF for more than one hour continuously on telemetry; or 2) The documentation of shorter AF as noted on 12-lead electrocardiogram; or 3) AF initiating either pharmacologic treatment or electrical cardioversion. Patients with a known history of AF prior to hospital admission were excluded. The primary outcome was hospital mortality. Secondary outcomes included resource utilization (mechanical ventilation, vasoactive medications, renal replacement therapy), and total costs. We used multivariable logistic regression to adjust for relevant confounders. To evaluate contributors to total cost, we utilized a generalized linear model with gamma distribution and log link.
 
RESULTS: We included 15,014 patients, and 1,541 (10.3%) had NOAF. Following adjustment for known confounders, NOAF was not associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 0.97-1.08) or discharge to long-term care (aOR 1.05 [95% CI: 0.92-1.14]). Among patients with NOAF, failure of cardioversion to sinus rhythm after 24 hours was associated with increased odds of hospital death (aOR 1.44 [95% CI: 1.18-1.74], as was a known history of heart failure (aOR 1.18 [95% CI: 1.04-1.32]. Patients with NOAF had prolonged median ICU length of stay (7 days vs. 6 days, P < 0.001), and NOAF was associated with higher total costs (cost ratio [CR]: 1.09 [95% CI: 1.02-1.20]). Among patients with NOAF, treatment with a rhythm control strategy was associated with higher costs (CR 1.24 [95% CI: 1.07-1.40]).
 
CONCLUSIONS: In our cohort of critically ill patients, NOAF was not associated with in-hospital death or discharge to long-term care. However, incidence of NOAF was associated with higher total costs. Among patients with NOAF, higher odds of mortality were seen among those who were unable to achieve cardioversion to sinus rhythm after 24 hours, and those with an existing diagnosis of heart failure. A rhythm control strategy among patients with NOAF was associated with higher costs. Taken together, this work provides novel insight related to NOAF in critically ill adult patients.
 


No references

ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Fernando, Shannon M., MD, MSc1,2; Mathew, Rebecca, MD1,3; Hibbert, Benjamin, MD, PhD3; Rochwerg, Bram, MD, MSc4,5; Munshi, Laveena, MD, MSc6,7; Walkey, Allan J., MD, MSc8,9; Møller, Morten Hylander, MD, PhD10; Simard, Trevor, MD3; Di Santo, Pietro, MD3; Ramirez, F. Daniel, MD3; Tanuseputro, Peter, MD, MHSc11, 12,13; Kyeremanteng, Kwadwo, MD, MHA1,11,13
 

  1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON.
  2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON.
  3. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON.
  4. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON.
  5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON.
  6. Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON.
  7. Department of Medicine, Sinai Health System, Toronto, ON.
  8. Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, MA.
  9. Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA.
  10. Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark.
  11. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.  
  12. Bruyere Research Institute, Ottawa, ON.
  13. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON.

INTRODUCTION: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence surrounding the association between NOAF and outcomes of critically ill patients is conflicting. Furthermore, little is known regarding the association between NOAF and resource utilization and hospital costs.   
 
OBJECTIVES: We sought to evaluate the association between NOAF and outcomes and costs of adult ICU patients. 
 
METHODS: We performed a retrospective analysis (2011-2016) of a prospectively collected registry from two hospitals of consecutive ICU patients ≥ 18 years of age. Atrial fibrillation (AF) detection was prospectively recorded by bedside nurses. NOAF was defined as either: 1) The observation of AF for more than one hour continuously on telemetry; or 2) The documentation of shorter AF as noted on 12-lead electrocardiogram; or 3) AF initiating either pharmacologic treatment or electrical cardioversion. Patients with a known history of AF prior to hospital admission were excluded. The primary outcome was hospital mortality. Secondary outcomes included resource utilization (mechanical ventilation, vasoactive medications, renal replacement therapy), and total costs. We used multivariable logistic regression to adjust for relevant confounders. To evaluate contributors to total cost, we utilized a generalized linear model with gamma distribution and log link.
 
RESULTS: We included 15,014 patients, and 1,541 (10.3%) had NOAF. Following adjustment for known confounders, NOAF was not associated with increased odds of hospital death (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 0.97-1.08) or discharge to long-term care (aOR 1.05 [95% CI: 0.92-1.14]). Among patients with NOAF, failure of cardioversion to sinus rhythm after 24 hours was associated with increased odds of hospital death (aOR 1.44 [95% CI: 1.18-1.74], as was a known history of heart failure (aOR 1.18 [95% CI: 1.04-1.32]. Patients with NOAF had prolonged median ICU length of stay (7 days vs. 6 days, P < 0.001), and NOAF was associated with higher total costs (cost ratio [CR]: 1.09 [95% CI: 1.02-1.20]). Among patients with NOAF, treatment with a rhythm control strategy was associated with higher costs (CR 1.24 [95% CI: 1.07-1.40]).
 
CONCLUSIONS: In our cohort of critically ill patients, NOAF was not associated with in-hospital death or discharge to long-term care. However, incidence of NOAF was associated with higher total costs. Among patients with NOAF, higher odds of mortality were seen among those who were unable to achieve cardioversion to sinus rhythm after 24 hours, and those with an existing diagnosis of heart failure. A rhythm control strategy among patients with NOAF was associated with higher costs. Taken together, this work provides novel insight related to NOAF in critically ill adult patients.
 


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