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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2019

01-07-2019 | Stroke | Review

New-onset atrial fibrillation in adult critically ill patients: a scoping review

Authors: Mik Wetterslev, Nicolai Haase, Christian Hassager, Emilie P. Belley-Cote, William F. McIntyre, Youzhong An, Jiawei Shen, Alexandre Biasi Cavalcanti, Fernando G. Zampieri, Helio Penna Guimaraes, Anders Granholm, Anders Perner, Morten Hylander Møller

Published in: Intensive Care Medicine | Issue 7/2019

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Abstract

Purpose

New-onset atrial fibrillation (NOAF) is common and associated with increased morbidity and mortality. However, its clinical importance and management in critically ill patients are not well described. The aim of this scoping review is to assess the epidemiology and management strategies of NOAF during critical illness.

Method

The review was conducted in accordance with the PRISMA extension for scoping reviews. We searched PubMed, EMBASE and the Cochrane Library for studies assessing the incidence, outcome and management strategies of NOAF in adult critically ill patients. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results

A total of 99 studies were included, of which 79 were observational and 20 were interventional. The incidence of NOAF varied from 1.7% to 43.9% with considerable inter-population variation (very low quality of evidence). Commonly identified risk factors for NOAF included higher age, cardiovascular comorbidities and sepsis. The occurrence of NOAF was associated with adverse outcomes, including stroke, prolonged length of stay and mortality (very low quality of evidence). We found limited data on the optimal management strategy with no evidence for firm benefit or harm for any intervention (very low/low quality of evidence).

Conclusions

The definition and incidence of NOAF in critically ill patients varied considerably and many risk factors were identified. NOAF seemed to be associated with adverse outcomes, but data were very limited and current management strategies are not evidence-based.
Appendix
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Metadata
Title
New-onset atrial fibrillation in adult critically ill patients: a scoping review
Authors
Mik Wetterslev
Nicolai Haase
Christian Hassager
Emilie P. Belley-Cote
William F. McIntyre
Youzhong An
Jiawei Shen
Alexandre Biasi Cavalcanti
Fernando G. Zampieri
Helio Penna Guimaraes
Anders Granholm
Anders Perner
Morten Hylander Møller
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 7/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05633-x

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Imaging in Intensive Care Medicine

Shaking and tremors in thyroid storm

What's new in Intensive Care

How to feed a patient with acute kidney injury

Understanding the Disease

Understanding the role of host response in influenza pneumonitis

Editorial

SUPERNOVA: will its energy trigger the formation of a new therapeutic star?