Preoperative atrial fibrillation tied to adverse outcomes after noncardiac surgery: JACC
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.
