title: Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients.
abstract: OBJECTIVE
  To derive a simple clinical prediction rule identifying patients at high risk of developing new-onset postoperative atrial fibrillation (POAF) after cardiac surgery.
  
  
  METHODS
  Retrospective analysis on prospectively collected observational data.
  
  
  METHODS
  A university-affiliated cardiac hospital.
  
  
  METHODS
  Adult patients undergoing coronary artery bypass grafting and/or valve surgery.
  
  
  METHODS
  Observation for the occurrence of new-onset postoperative atrial fibrillation.
  
  
  RESULTS
  Details on 28 preoperative variables from 999 patients were collected and significant predictors (p<0.2) were inserted into multivariable logistic regression and reconfirmed with recursive partitioning. A total of 305 (30.5%) patients developed new-onset POAF. Eleven variables were associated significantly with atrial fibrillation. A multivariable logistic regression model included left atrial dilatation, mitral valve disease, and age. Coefficients from the model were converted into a simple 7-point predictive score. The risk of POAF per score is: 15.0%, if 0; 20%, if 1; 27%, if 2; 35%, if 3; 44%, if 4; 53%, if 5; 62%, if 6; and 70%, if 7. A score of 4 has a sensitivity of 44% and a specificity of 82% for POAF. A score of 6 has a sensitivity of 11% and a specificity of 97%. Bootstrapping with 5,000 samples confirmed the final model provided consistent predictions.
  
  
  CONCLUSIONS
  This study proposed a simple predictive score incorporating three risk variables to identify cardiac surgical patients at high risk of developing new-onset POAF. Preventive treatment should target patients ≥ 65 years with left atrial dilatation and mitral valve disease.
authors: Division of Cardiac Anesthesiology, Department of Anesthesiology. Electronic address: dtran@ottawaheart.ca.
authors: Diem T T
authors: DT
authors: Tran
authors: Ottawa Hospital Research Institute, Department of Emergency Medicine, The Ottawa Hospital, Ottawa, Ontario.
authors: Jeffery J
authors: JJ
authors: Perry
authors: Division of Cardiac Anesthesiology, Department of Anesthesiology.
authors: Jean-Yves
authors: JY
authors: Dupuis
authors: Division of Cardiac Surgery, Department of Surgery.
authors: Elsayed
authors: E
authors: Elmestekawy
authors: Cardiovascular Research Methods Center, Department of Epidemiology and Community Medicine, The University of Ottawa Heart Institute, Ottawa, Ontario.
authors: George A
authors: GA
authors: Wells
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis*; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: atrial fibrillation; cardiac surgery; postoperative complication; prediction rule