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.

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: To describe the characteristics, management and outcomes of hospitalised adult patients with new‐onset AF. Methods: 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. Results: 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: 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. [ABSTRACT FROM AUTHOR]

Copyright of Internal Medicine Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)