title: Preoperative atrial fibrillation and long-term survival after open heart surgery in a rural tertiary heart institute.
abstract: BACKGROUND
  Preoperative atrial fibrillation (AF) is associated with increased morbidity and mortality after open heart surgery. However, the impact of preoperative AF on long-term survival after open heart surgery has not been widely examined in rural populations. Patients from rural regions are less likely to receive treatment for cardiac conditions and to have adequate medical insurance coverage.
  
  
  OBJECTIVE
  To examine the influence of preoperative AF on long-term survival following open heart surgery in rural eastern North Carolina.
  
  
  METHODS
  Long-term survival was compared in patients with and without preoperative AF after coronary artery bypass grafting (CABG) and CABG plus valve (CABG + V) surgery between 2002 and 2011. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model.
  
  
  RESULTS
  The study population consisted of 5438 patients. A total of 263 (5%) patients had preoperative AF. Preoperative AF was an independent predictor of long-term survival (open heart surgery: adjusted HR = 1.6, 95% CI = 1.3-2.0; CABG: adjusted HR = 1.6, 95% CI = 1.3-2.1; CABG + V: adjusted HR = 1.6, 95% CI = 1.1-2.3).
  
  
  CONCLUSIONS
  Preoperative AF is an important predictor of long-term survival after open heart surgery in this rural population.
authors.affiliation: Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. Electronic address: woneal@wakehealth.edu.
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Davies
authors.forename: Yuk Ming
authors.initials: YM
authors.lastname: Choi
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Anderson
authors.forename: Linda C
authors.initials: LC
authors.lastname: Kindell
authors.forename: Jason B
authors.initials: JB
authors.lastname: O'Neal
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
authors.forename: Alan P
authors.initials: AP
authors.lastname: Kypson
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D002300:Cardiac Care Facilities; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D019035:Rural Health Services; D016019:Survival Analysis
keywords: AF; Atrial fibrillation; Bypass; CABG; CABG plus valve surgery; CABG + V; CAD; CI; Coronary disease; HR; STS; Society of Thoracic Surgeons; Survival; atrial fibrillation; confidence interval; coronary artery bypass grafting; coronary artery disease; hazard ratio