title: The burden and implications of preoperative atrial fibrillation in Australian heart valve surgery patients.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common preoperative arrhythmia in heart valve surgery patients and its prevalence is rising. This study aims to investigate the impact of AF on valve surgery early complications and survival and on valve disease of different aetiologies and populations with particular reference to Indigenous Australians with rheumatic heart disease (RHD).
  
  
  METHODS
  The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to determine the association between preoperative AF and valve surgery outcome. Its association with demographics, co-morbidities, preoperative status and short and long term outcome was assessed.
  
  
  RESULTS
  Outcome of 1594 RHD and 19,029 non-RHD-related surgical procedures was analysed. Patients with preoperative AF were more likely to be older, female, Indigenous, to have RHD and to bear a greater burden of comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2-1.7) and long term (HR 1.5, 95% CI 1.3-1.7) survival was inferior for patients with non-RHD preoperative AF but was no different for Indigenous and non-Indigenous Australians with RHD.
  
  
  CONCLUSIONS
  In this prospective Australian study, patients with valve disease and preoperative AF had inferior short and long term survival. This was particularly the case for patients with non-RHD valve disease. Earlier intervention or more aggressive AF management should be investigated as mechanisms for enhancing postoperative outcomes. This may influence treatment choice and the need for ongoing anticoagulation.
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: anne.russell@monash.edu.
authors.forename: E Anne
authors.initials: EA
authors.lastname: Russell
authors.affiliation: Prince of Wales Hospital, Randwick, NSW. Australia. Electronic address: warren.walsh@ehc.com.au.
authors.forename: Warren F
authors.initials: WF
authors.lastname: Walsh
authors.affiliation: School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: lavinia.tran@monash.edu.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Tran
authors.affiliation: Department of Cardiothoracic Surgery, Townsville, Hospital, Queensland, Australia. Electronic address: robert.tam@health.qld.gov.au.
authors.forename: Robert
authors.initials: R
authors.lastname: Tam
authors.affiliation: School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Public Health, Curtin University, Perth, WA, Australia. Electronic address: christopher.reid@curtin.edu.au.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, SA, Australia; School of Population Health, University of South Australia, Adelaide, SA, Australia. Electronic address: alex.brown@sahmri.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
authors.affiliation: Department of Surgery, School of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA, Australia. Electronic address: Jayme.Bennetts@health.sa.gov.au.
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Bennetts
authors.affiliation: Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA, Australia. Electronic address: Rob.Baker@health.sa.gov.au.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Medicine, James Cook University, Cairns, Queensland, Australia. Electronic address: graeme.maguire@bakeridi.edu.au.
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Maguire
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery*; D001315:Australia / Q000208:ethnology; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000208:ethnology; D011183:Postoperative Complications / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery*; D011300:Preoperative Care / Q000639:trends; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends
keywords: Atrial fibrillation; Cardiac surgery; Valve disease surgery; Valvular heart disease