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Preoperative atrial fibrillation tied to adverse outcomes after noncardiac surgery: JACC
![Preoperative atrial fibrillation tied to adverse outcomes after noncardiac surgery: JACC Preoperative atrial fibrillation tied to adverse outcomes after noncardiac surgery: JACC](https://medicaldialogues.in/h-upload/2020/01/18/750x450_123257-atrial-fibrillation.jpg)
USA: A recent study in the Journal of the American College of Cardiology (JACC) found pre-existing atrial fibrillation to be independently associated with postoperative unfavorable outcomes following noncardiac surgery (NCS).
Atrial fibrillation whether perioperative, pre-existing, or postoperative poses a unique challenge, and is shown to be associated with worse outcomes in the surgical settings. The data is scant regarding outcomes associated with pre-existing AF in the setting of noncardiac surgery despite robust retrospective analyses of perioperative.
Considering the above, Sameer Prasada, Heart, Thoracic and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA, and colleagues aimed to study the impact of AF on the risk of adverse outcomes after noncardiac surgery in a nationwide cohort.
For this purpose, the researchers identified Medicare beneficiaries admitted for noncardiac surgery from 2015 to 2019. The study cohort was divided into 2 groups: with and without AF. Noncardiac surgery was classified into thoracic, vascular, general, gynecological, genitourinary, neurosurgery and orthopedics, breast, head and neck, and transplant.
Propensity score matching was used on exact age, sex, race, urgency, and type of surgery, revised cardiac risk index (RCRI) and CHA2DS2-VASc score, and tight caliper on other comorbidities. The study outcomes were myocardial infarction, heart failure, stroke, and 30-day mortality. The incremental utility of AF was examined in addition to RCRI to predict adverse events after noncardiac surgery.
Based on the study, the authors reported the following findings:
- The study cohort included 8,635,758 patients who underwent noncardiac surgery (16.4% with AF).
- Patients with AF were older, more likely to be men, and had a higher prevalence of comorbidities.
- After propensity score matching, AF was associated with a higher risk of mortality (OR: 1.31), heart failure (OR: 1.31), stroke (OR: 1.40), and lower risk of myocardial infarction (OR: 0.81).
- Results were consistent in subgroup analysis by sex, race, type of surgery, and all strata of RCRI and CHA2DS2-VASc score. AF improved the discriminative ability of RCRI.
The researchers conclude by writing that, "Pre-existing AF is independently associated with postoperative adverse outcomes after NCS."
Reference:
Prasada S, Desai MY, Saad M, Smilowitz NR, Faulx M, Menon V, Moudgil R, Chaudhury P, Hussein AA, Taigen T, Nakhla S, Mentias A. Preoperative Atrial Fibrillation and Cardiovascular Outcomes After Noncardiac Surgery. J Am Coll Cardiol. 2022 Jun 28;79(25):2471-2485. doi: 10.1016/j.jacc.2022.04.021. PMID: 35738707.
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751