New Onset Atrial Fibrillation in Hospitalized Patients.

Abstract

Objectives: To evaluate different factors precipitating new onset atrial fibrillation (AF) in hospitalized patients and their effect on in-patient mortality.

Design: Retrospective cross-sectional study.

Setting: Urban tertiary care center in New York City.

Measurements: Primary outcomes:Determine different factors precipitating new onset atrial fibrillation in hospitalized patients and their effect on in-patient mortality.Secondary outcomes:Determine the duration of hospital stay after admission precipitating new onset atrial fibrillation and its effect on mortality.Evaluate different factors in COVID-19 patients with new onset atrial fibrillation.

Results: Out of 464 patients; 62.3 % were males and 37.72 % were females. Evaluation of patients before developing new onset AF showed that 75.86 % had hypertension, 41.38 % had heart failure and 42.67 % had ischemic heart disease (IHD). Younger patients were noted to be treated with more rhythm control as compared to rate control (52.38 % vs 38.1 %) for their management while opposite was observed with patients >50 years of age (70.88 % vs 52.6 %; rate control vs rhythm control respectively). In terms of mortality, female gender (OR = 2.63, 95 % CI: 1.03-6.94, p = 0.045), presence of infection (OR = 6.00, 95 % CI: 2.23-18.08, p <0.001), use of vasopressors (OR = 6.71, 95 % CI: 2.58-19.42, p< 0.001), and a history of CVA (OR = 6.98, 95 % CI: 1.99-24.58, p = 0.002) all significantly increased the odds for mortality. Majority of the patients; 54.31 %, developed new onset AF after the third day of admission but it did not increase the mortality (OR 0.93, 95 % CI 0.37-2.45, p = 0.884). Majority of the patients (67 %) had enlarged left atrium (>35 ml/m²). However, it was not associated with higher mortality (OR 0.53, 95 % CI 0.19-1.48, p = 0.223). Patients that were tested positive for COVID-19 were more likely to have sepsis (75 % vs 31.46 %, p< 0.001).

Conclusion: This study finds that four factors i.e., female gender, presence of infection, use of vasopressors, and a history of CVA all precipitate new onset atrial fibrillation with resultant increase in mortality during the same admission. Study concludes that longer hospital stay of more than three days increases the likelihood of developing new onset atrial fibrillation without increasing the mortality. Study found that patients who were positive forCOVID-19 were more likely to have sepsis.