Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery
Wang, Michael Ke (McMaster University (Canadà))
Devereaux, P. J. (McMaster University (Canadà))
Marcucci, Maura (McMaster University (Canadà))
Lomivorotov, Vladimir (Penn State Health Milton S. Hershey Medical Center (Estats Units d'Amèrica))
Sessler, Daniel (University of Texas Health Science Center (Estats Units d'Amèrica))
Chan, Matthew T. V. (The Chinese University of Hong Kong (Xina))
Kessler Borges, Flavia (McMaster University (Canadà))
Ofori, Sandra N. (McMaster University (Canadà))
Paniagua, Pilar (Institut de Recerca Sant Pau)
Douketis, James Demetrios (St. Joseph's Healthcare Hamilton (Canadà))
Sigamani, Aalben (Carmel Research (Índia))
Parlow, Joel L. (Kingston Health Sciences Centre (Canadà))
Wang, Chew Y. (Universiti Malaya (Malàisia))
Villar, Juan Carlos (Universidad Autónoma de Bucaramanga)
Srinathan, Sadeesh K. (University of Manitoba (Canadà))
Szczeklik, Wojciech (Jagiellonian University Medical College (Polònia))
Martinez-Zapata, Maria José (Institut de Recerca Sant Pau)
Malaga, German (Universidad Peruana Cayetano Heredia)
Sivakumaran, Soori (University of Alberta (Canadà))
McIntyre, William F. (McMaster University (Canadà))
Rodríguez Funes, Maria Virginia (Hospital Nacional Rosales (El Salvador))
Cruz, Patricia (Hospital General Universitario Gregorio Marañón)
Alvarez-Garcia, Jesus (Universitat Autònoma de Barcelona)
Greiss, Isabelle (University of Montreal Hospital Center (Canadà))
Popova, Ekaterine (Centro Cochrane Iberoamericano (CCIb))
Hemels, Martin E. (Dutch Cardiovascular Research Network (WCN)(Països Baixos))
Brandes, Axel (University of Southern Denmark (Dinamarca))
Chow, Clara K. (Westmead Hospital)
Barnawal, Satish Prasad (Baidya and Banskota Hospital (Nepal))
Healey, Jeff S. (McMaster University (Canadà))
Conen, David (McMaster University (Canadà))

Date:	2024
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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	CJC Open, Vol. 6 Núm. 11 (november 2024) , p. 1363-1371, ISSN 2589-790X

DOI: 10.1016/j.cjco.2024.08.003
PMID: 39582707

9 p, 871.6 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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