Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery

Authors

• Michael Ke Wang
• P J Devereaux
• Maura Marcucci
• Vladimir Lomivorotov
• Daniel I Sessler
• Matthew T V Chan
• Flavia K Borges
• Sandra N Ofori
• Pilar Paniagua
• James D Douketis
• Alben Sigamani
• Joel L Parlow
• Chew Y Wang
• Juan Carlos Villar
• Sadeesh K Srinathan
• Wojciech Szczeklik
• María José Martínez-Zapata
• German Malaga
• Soori Sivakumaran
• William F McIntyre
• María-Virginia Rodríguez Funes
• Patricia Cruz
• Jesús Alvarez-Garcia
• Isabelle Greiss
• Ekaterine Popova
• Martin E Hemels
• Axel Brandes
• Clara K Chow
• Satish Prasad Barnawal
• Jeff S Healey
• David Conen

Language

English

Publication Date

11-1-2024

Journal

CJC Open

DOI

10.1016/j.cjco.2024.08.003

PMID

39582707

PMCID

PMC11583878

PubMedCentral® Posted Date

8-17-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time.

Methods: We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression.

Results: Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3-16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11).

Conclusions: Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population.

Published Open-Access

yes

Recommended Citation

Wang, Michael Ke; Devereaux, P J; Marcucci, Maura; et al., "Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery" (2024). Faculty, Staff and Student Publications. 1526.
https://digitalcommons.library.tmc.edu/uthsph_docs/1526