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Long-Term Impact of Newly Diagnosed Atrial Fibrillation During Critical Care: A South Korean Nationwide Cohort Study

Authors
 Kyu Kim  ;  Pil-Sung Yang  ;  Eunsun Jang  ;  Hee Tae Yu  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Jong-Youn Kim  ;  Jung-Hoon Sung  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Gregory Y.H. Lip  ;  Boyoung Joung 
Citation
 Chest, Vol.156(3) : 518-528, 2019 
Journal Title
 Chest 
ISSN
 0012-3692 
Issue Date
2019
Keywords
atrial fibrillation ; critical care ; mortality ; stroke ; thromboembolism
Abstract
BACKGROUND: The long-term risks of thromboembolism and mortality are unknown in patients who survived following atrial fibrillation (AF) newly diagnosed during critical care. METHODS: Using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for > 6 months following AF newly diagnosed during critical care (ICU-AF), 269,751 control subjects with non-ICU AF (AF-control), and 439,868 control subjects without AF (No-AF) from 2005 to 2013. We performed propensity score matching and compared the risks of stroke/systemic embolism and all-cause mortality. RESULTS: The adjusted hazard ratios (HRs) for long-term stroke/systemic embolism in the patients with ICU-AF were 0.93 (95% CI, 0.88-0.98) compared with the AF-control group and 1.50 (95% CI, 1.42-1.60) compared with the No-AF group. The adjusted HRs of the ICU-AF group for long-term mortality were 1.73 (95% CI, 1.70-1.83) and 3.20 (95% CI, 3.08-3.33) compared with the AF-control and No-AF groups, respectively. The risks of stroke/systemic embolism and mortality were significantly higher in the ICU-AF group than in the No-AF group after excluding patients with AF recurrence (adjusted HR, 1.08; 95% CI, 1.01-1.17), regardless of the causes of critical care and cardiovascular or noncardiovascular surgery. CONCLUSIONS: The patients who survived following AF newly diagnosed during critical care remained at a higher risk of long-term stroke/systemic embolism and mortality than the patients without AF regardless of AF recurrence and the causes of critical care. Close follow-up and continuous anticoagulation might be needed for these patients.
Full Text
https://www.sciencedirect.com/science/article/pii/S0012369219308761
DOI
10.1016/j.chest.2019.04.011
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyu(김규)
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/171429
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