TY - JOUR
T1 - Predictors of atrial fibrillation after coronary artery surgery
T2 - Current trends and impact on hospital resources
AU - Aranki, Sary F.
AU - Shaw, David P.
AU - Adams, David H.
AU - Rizzo, Robert J.
AU - Couper, Gregory S.
AU - VanderVliet, Martha
AU - Collins, John J.
AU - Cohn, Lawrence H.
AU - Burstin, Helen R.
PY - 1996
Y1 - 1996
N2 - Background: Atrial fibrillation (AF) after coronary artery bypass surgery (CABG) is the most common sustained arrhythmia. Its pathophysiology is unclear, and its prevention and management remain suboptimal. The aim of this prospective study was to determine the current incidence of AF, identify its clinical predictors, and examine its impact on resource utilization. Methods and Results: Over a 12-month period ending July 31, 1994, a CABG procedure was performed on 570 consecutive patients (age range, 32 to 87 years; median age, 67 years; 232 [41%] were ≤70 years; 175 [31%] were women; 173 [30%] were diabetics; 364 [65%] required nonelective surgery; 86 [15%] had had a prior CABG; and 86 [15%] had had prior percutaneous transluminal coronary angioplasty). AF occurred in 189 patients (33%). The median age for patients with AF was 71 years compared with 66 for patients without (P=.0001). Multivariate logistic regression analysis (odds ratio, ±95% CI, P value) was used to identify the following independent predictors of postoperative AF: increasing age (age 70 to 80 years [OR=2; CI, 1.3 to 3; P=.002], age >80 years [OR=3; CI, 1.6 to 5.8; P=.0007]), male gender (OR=1.7; CI, 1.1 to 2.7: P=.01), hypertension (OR= 1.6; CI, 1.0 to 2.3; P=.03), need for an intraoperative intraaortic balloon pump (OR=3.5; CI, 1.2 to 10.9; P=.03), postoperative pneumonia (OR=3.9: CI, 1.3 to 11.5; P=.01), ventilation for >24 hours (OR=2; CI, 1.3 to 3.2; P=.003), and return to the intensive care unit (OR=3.2; CI, 1.1 to 8.8; P=.03). The mean length of hospital stay after surgery was 15.3±28.6 days for patients with AF compared with 9.3 ± 19.6 days for patients without AF (P=.001). The adjusted length of hospital stay attributable to AF was 4.9 days, corresponding to ≤$10 055 in hospital charges. Conclusions: AF remains the most common complication after CABG and consequently is a drain on hospital resources. Concerted efforts to reduce the incidence of AF and the associated increased length of stay would result in substantial cost savings and decrease patient morbidity.
AB - Background: Atrial fibrillation (AF) after coronary artery bypass surgery (CABG) is the most common sustained arrhythmia. Its pathophysiology is unclear, and its prevention and management remain suboptimal. The aim of this prospective study was to determine the current incidence of AF, identify its clinical predictors, and examine its impact on resource utilization. Methods and Results: Over a 12-month period ending July 31, 1994, a CABG procedure was performed on 570 consecutive patients (age range, 32 to 87 years; median age, 67 years; 232 [41%] were ≤70 years; 175 [31%] were women; 173 [30%] were diabetics; 364 [65%] required nonelective surgery; 86 [15%] had had a prior CABG; and 86 [15%] had had prior percutaneous transluminal coronary angioplasty). AF occurred in 189 patients (33%). The median age for patients with AF was 71 years compared with 66 for patients without (P=.0001). Multivariate logistic regression analysis (odds ratio, ±95% CI, P value) was used to identify the following independent predictors of postoperative AF: increasing age (age 70 to 80 years [OR=2; CI, 1.3 to 3; P=.002], age >80 years [OR=3; CI, 1.6 to 5.8; P=.0007]), male gender (OR=1.7; CI, 1.1 to 2.7: P=.01), hypertension (OR= 1.6; CI, 1.0 to 2.3; P=.03), need for an intraoperative intraaortic balloon pump (OR=3.5; CI, 1.2 to 10.9; P=.03), postoperative pneumonia (OR=3.9: CI, 1.3 to 11.5; P=.01), ventilation for >24 hours (OR=2; CI, 1.3 to 3.2; P=.003), and return to the intensive care unit (OR=3.2; CI, 1.1 to 8.8; P=.03). The mean length of hospital stay after surgery was 15.3±28.6 days for patients with AF compared with 9.3 ± 19.6 days for patients without AF (P=.001). The adjusted length of hospital stay attributable to AF was 4.9 days, corresponding to ≤$10 055 in hospital charges. Conclusions: AF remains the most common complication after CABG and consequently is a drain on hospital resources. Concerted efforts to reduce the incidence of AF and the associated increased length of stay would result in substantial cost savings and decrease patient morbidity.
KW - atrial fibrillation
KW - atrial flutter
KW - bypass surgery
KW - coronary disease
UR - http://www.scopus.com/inward/record.url?scp=0029815621&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.94.3.390
DO - 10.1161/01.CIR.94.3.390
M3 - Article
C2 - 8759081
AN - SCOPUS:0029815621
SN - 0009-7322
VL - 94
SP - 390
EP - 397
JO - Circulation
JF - Circulation
IS - 3
ER -