title: Duration of Postoperative Atrial Fibrillation After Cardiac Surgery Is Associated With Worsened Long-Term Survival.
abstract: BACKGROUND
  Studies of the effects of postoperative atrial fibrillation (poAF) on long-term survival are conflicting, likely because of comorbidities that occur with poAF and the patient populations studied. Furthermore, the effects of poAF duration on long-term survival are poorly understood.
  
  
  METHODS
  We utilized a prospectively collected database on outcomes of cardiac surgery at a large tertiary care institution between August 2001 and December 2010 with survival follow-up through June 2015 to analyze long-term survival of patients with poAF. In addition, we identified patient- and procedure-related variables associated with poAF, and estimated overall comorbidity burden using the Elixhauser comorbidity index. Survival was compared between patients with poAF (n = 513) and a propensity score matched control cohort, both for all patients and separately for subgroups of patients with poAF lasting less than 2 days (n = 218) and patients with prolonged poAF (n = 265).
  
  
  RESULTS
  Patients with poAF were older and had a higher burden of comorbidities. Survival was significantly worse for patients with poAF than for the matched control group (hazard ratio 1.43, 95% confidence interval: 1.11 to 1.86). That was driven by decreased survival among patients with prolonged poAF (hazard ratio 1.97, 95% confidence interval: 1.37 to 2.80), whereas survival of patients with poAF for less than 2 days was not significantly different from that of matched controls (hazard ratio 0.91, 95% confidence interval: 0.60 to 1.39).
  
  
  CONCLUSIONS
  After close matching based on comorbidity burden, prolonged poAF is still associated with decreased survival. Therefore, vigilance is warranted in monitoring and treating patients with prolonged poAF after cardiac surgery.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Martin I
authors.initials: MI
authors.lastname: Sigurdsson
authors.affiliation: Division of Medicine, Imperial College, London, United Kingdom.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Longford
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mahyar
authors.initials: M
authors.lastname: Heydarpour
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Louis
authors.initials: L
authors.lastname: Saddic
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tzuu-Wang
authors.initials: TW
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Fox
authors.affiliation: Division of Cardiovascular Anesthesia, Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, Texas.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Collard
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sary
authors.initials: S
authors.lastname: Aranki
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Prem
authors.initials: P
authors.lastname: Shekar
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jochen D
authors.initials: JD
authors.lastname: Muehlschlegel
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: scbody@partners.org.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Body
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006348:Cardiac Surgical Procedures; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents