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Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery

Wang MK 1 , Devereaux PJ 1 , Marcucci M 1 , Lomivorotov V 2 , Sessler DI 3 , Chan MTV 4 Show all authors , Borges FK 1 , Ofori SN 1 , Paniagua P 5 , Douketis JD 1 , Sigamani A 6 , Parlow JL 7 , Wang CY 8 , Villar JC 9 , Srinathan SK 10 , Szczeklik W 11 , Martínez-Zapata MJ 12 , Malaga G 13 , Sivakumaran S 14 , McIntyre WF 1 , Rodríguez Funes MV 15 , Cruz P 16 , Alvarez-Garcia J 17 , Greiss I 18 , Popova E 19 , Hemels ME 20 , Brandes A 21 , Chow CK 22 , Barnawal SP 23 , Healey JS 1 , Conen D 1

Affiliations 

  • 1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  • 2 E. Meshalkin National Medical Research Center, Department of Anesthesiology and Intensive Care, Novosibirsk, Russia
  • 3 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 4 The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
  • 5 Department of Anesthesia, University Hospital Santa Creu i Sant Pau, Barcelona, Spain
  • 6 Numen Health, Bangalore, India
  • 7 Queens University, Kingston, Ontario, Canada
  • 8 Universiti Malaya, Kuala Lumpur, Malaysia
  • 9 Research Centre, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
  • 10 University of Manitoba, Winnipeg, Manitoba, Canada
  • 11 Jagiellonian University Medical College, Centre for Intensive Care and Perioperative Medicine, Kraków, Poland
  • 12 Iberoamerican Cochrane Center, IIB Sant Pau, Barcelona, Spain
  • 13 CONEVID, Universidad Peruana Cayetano Heredia, Lima, Perú
  • 14 Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
  • 15 Hospital Nacional Rosales, San Salvador, El Salvador
  • 16 Hospital General University Gregorio Marañón, Madrid, Spain
  • 17 Department of Cardiology at Ramón y Cajal University Hospital, Madrid, Spain
  • 18 University of Montreal Hospital Center, Montreal, Quebec, Canada
  • 19 Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
  • 20 Rijnstate Hospital, Arnhem, the Netherlands
  • 21 Department of Cardiology, Odense University Hospital, Odense, Denmark
  • 22 Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
  • 23 B and B Hospital, Gwarko, Lalitpur, Nepal
CJC Open, 2024 Nov;6(11):1363-1371.
PMID: 39582707 DOI: 10.1016/j.cjco.2024.08.003

Abstract

BACKGROUND: Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time.

METHODS: We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression.

RESULTS: Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3-16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11).

CONCLUSIONS: Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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