1 in 3 adults with new-onset afib during hospitalization have recurrence within a year
The findings suggest that patients who experience a transient episode of atrial fibrillation during hospitalization need risk stratification and follow-up, according to the authors of the matched cohort study.
Among patients who have a first atrial fibrillation (AF) episode during hospitalization, one in three will have recurrence within a year, a rate approximately seven times higher than in matched control participants, a study found.
To estimate risk for AF recurrence in patients with new-onset AF during a hospitalization for noncardiac surgery or medical illness compared to those without AF, researchers conducted a matched cohort study in three academic hospitals in Ontario, Canada. For each of 139 patients hospitalized for noncardiac surgery or medical illness who had transient new-onset AF, an age- and sex-matched control participant with no history of AF from the same hospital ward was recruited. All participants left the hospital in sinus rhythm.
Study participants in both groups were monitored by EKG for 14 days at one and six months and underwent telephone assessment at one, six, and 12 months. The primary outcome was AF lasting at least 30 seconds on the monitor or captured by a 12-lead EKG during routine care at 12 months. The study was published by Annals of Internal Medicine on Oct. 3.
At one year, recurrent AF had been detected in 33.1% (95% CI, 25.3% to 40.9%) of participants in the transient new-onset AF group and 5.0% (95% CI, 1.4% to 8.7%) of matched control participants (adjusted relative risk, 6.6; 95% CI, 3.2 to 13.7). After 40 participants who had electrical or pharmacologic cardioversion during the index hospitalization and their matched control participants were excluded and the analysis was limited to AF events detected by the EKG patch, recurrent AF was detected in 32.3% (95% CI, 23.1% to 41.5%) of participants with transient new-onset AF and 3.0% (95% CI, 0% to 6.4%) of matched control participants.
“This study has important implications for management of patients who have a first presentation of AF that is concurrent with a reversible physiologic stressor,” the study authors wrote. “An AF recurrence risk of 33.1% at 1 year is neither low enough to conclude that transient new-onset AF in the setting of another illness is benign nor high enough that all such transient new-onset AF can be assumed to be paroxysmal AF. Instead, these results call for risk stratification and follow-up in these patients.”