A CHADS2 score, which is associated with a risk of post-operative atrial fibrillation (AF) in cardiac patients, is also predictive of AF in non-cardiac patients after major thoracic or vascular surgery, researchers said here on January 18 at the Society of Critical Care Medicine (SCCM) 44th Critical Care Congress.
“CHADS 2 appears to be associated with an increased risk of postoperative AF with every unit increase in score, and perhaps baseline assessment of this in these patients may aid in predicting patients at greater risk of who do not have AF at baseline,” said Kirstin Kooda, PharmD, Mayo Clinic, Rochester, Minnesota.
A score of ≥2 on CHADS2 has been linked to new onset AF in cardiac surgery patients; however, less is known of its predictive role in patients undergoing non-cardiac or vascular surgeries, who are also at risk.
“Incidence of new onset postoperative atrial fibrillation ranges from 9% to 20% in non-cardiac major thoracic and vascular surgeries and is associated with worse postoperative outcomes,” the authors wrote in their presentation.
In order to try to better understand the risk factors in the non-cardiac surgery population, the researchers evaluated data on 1,566 patients without known AF who were admitted to a surgical intensive care unit (ICU) following major non-cardiac thoracic and vascular surgery between 2006 and 2013.
Among the patients, 221 (14.1%) developed post-operative AF, with a median onset of 55 hours following their surgery.
In a univariate analysis, a higher CHADS2 score was associated with an increased risk of post-operative AF (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.08-1.37 for every unit increase in score).
The association remained after adjusting for variables including electrolyte values and daily fluid balance, vasopressor and inotrope requirements during and after surgery, the length of operation, and blood transfusion (HR, 1.17; 95% CI, 1.04-1.31).
Aside from CHADS2 score, other factors that predicted post-operative AF included intraoperative fluid administration (HR, 1.03; 95% CI, 1.01-1.06 per 1000 ml), the use of preoperative beta blockers (HR, 2.04; 95% CI, 1.44-2.90), use of calcium channel blockers (HR, 0.67; 95% CI, 0.49-0.93), and postoperative day 1 Sequential Organ Failure Assessment (SOFA) score (HR, 1.08; 95% CI, 1.03-1.12 for every unit increase in score).
“The findings suggest that CHADS 2 appears to be associated with an increased risk of post-op AF with every unit increase in score, said Dr. Kooda. “Our thought is that now that we know this potentially works, when we see these patients coming in for major vascular and thoracic surgery, we can have a heightened awareness of their potential risk for developing post-op AFIB.”
<h3>References</h3>
http://dgnews.docguide.com/chads2-linked-post-op-atrial-fibrillation-following-non-cardiac-surgery?overlay=2&nl_ref=newsletter&pk_campaign=newsletter
