title: Atrial Fibrillation Is an Independent Predictor of Mortality in Critically Ill Patients.
abstract: OBJECTIVE
  Atrial fibrillation has been associated with increased mortality in critically ill patients. We sought to determine whether atrial fibrillation in the ICU is an independent risk factor for death. A secondary objective was to determine if patients with new-onset atrial fibrillation have different risk factors or outcomes compared with patients with a previous history of atrial fibrillation.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Medical and general surgical ICUs in a tertiary academic medical center.
  
  
  METHODS
  One thousand seven hundred seventy critically ill patients requiring at least 2 days in the ICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  Demographics, medical history, development of atrial fibrillation, fluid balance, echocardiographic findings, medication administration, and hospital mortality were collected during the first 4 days of ICU admission. Atrial fibrillation occurred in 236 patients (13%) (Any AF). Of these, 123 patients (7%) had no prior atrial fibrillation (New-onset AF) while the remaining 113 (6%) had recurrent atrial fibrillation (Recurrent AF). Any AF was associated with male gender, Caucasian race, increased age, cardiac disease, organ failures, and disease severity. Patients with Any AF had increased mortality compared with those without atrial fibrillation (31% vs 17%; p < 0.001), and Any AF was independently associated with death (odds ratio, 1.62; 95% CI, 1.14-2.29; p = 0.007) in multivariable analysis controlling for severity of illness and other confounders. The association of atrial fibrillation with death was magnified in patients without sepsis (odds ratio, 2.92; 95% CI, 1.52-5.60; p = 0.001). Treatment for atrial fibrillation had no effect on hospital mortality. New-onset AF and Recurrent AF were each associated with increased mortality. New-onset AF, but not Recurrent AF, was associated with increased diastolic dysfunction and vasopressor use and a greater cumulative positive fluid balance.
  
  
  CONCLUSIONS
  Atrial fibrillation in critical illness, whether new-onset or recurrent, is independently associated with increased hospital mortality, especially in patients without sepsis.
authors.affiliation: 1Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 2Division of Pulmonary and Critical Care Medicine, Chiayi Christian Hospital, Chiayi, Taiwan. 3Section of Pulmonary and Critical Care Medicine, Louisiana State University School of Medicine New Orleans, LA. 4Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN. 5Division of Cardiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. 6Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Ciara M
authors.initials: CM
authors.lastname: Shaver
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: David R
authors.initials: DR
authors.lastname: Janz
authors.forename: Addison K
authors.initials: AK
authors.lastname: May
authors.forename: Dawood
authors.initials: D
authors.lastname: Darbar
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bastarache
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality*; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors