Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery

Wang M.K.; Devereaux P.J.; Marcucci M.; Lomivorotov V.; Sessler D.I.; Chan M.T.V.; Borges F.K.; Ofori S.N.; Paniagua P.; Douketis J.D.; Sigamani A.; Parlow J.L.; Wang C.Y.; Villar J.C.; Srinathan S.K.; Szczeklik W.; Martínez-Zapata M.J.; Malaga G.; Sivakumaran S.; McIntyre W.F.; Rodríguez Funes M.-V.; Cruz P.; Alvarez-Garcia J.; Greiss I.; Popova E.; Hemels M.E.; Brandes A.; Chow C.K.; Barnawal S.P.; Healey J.S.; Conen D. · CJC Open (2024) · DOI: 10.1016/j.cjco.2024.08.003

Resumen

Background: Clinically important perioperative atrial fibrillation (POAF) is a common cardiac complication after noncardiac surgery. Little is known about how patients with POAF are managed acutely and whether practices have changed over time. Methods: We conducted an observational substudy of patients who had POAF, were at elevated cardiovascular risk, and were enrolled in the PeriOperative Ischemic Evaluation (POISE)-1, 2 and 3 trials between 2002 and 2021. POAF was defined as new, clinically important atrial fibrillation occurring within 30 days after surgery. We assessed the use of rhythm-control and anticoagulation treatment in response to POAF, at hospital discharge and at 30 days after surgery. We assessed for temporal trends using multivariable logistic regression. Results: Of the 27,896 patients included, 545 (1.9%) developed clinically important POAF. Patients received rhythm-control treatment in 48.6% of cases. The level of use of rhythm-control treatment increased over the course of the trials (POISE-1 vs POISE-2 vs POISE-3; 40.9% vs 49.5% vs 59.1%). A later randomization date was associated independently with use of rhythm-control treatment (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.09). Anticoagulation treatment was prescribed in 21% of POAF cases. The level of anticoagulation treatement use was higher in POISE-3, compared to that in the 2 previous trials (POISE-1 vs POISE-2 vs POISE-3—16.4% vs 16.5% vs 33.6%). A later randomization date was associated independently with use of anticoagulation treatment (odds ratio, 1.06 per year; 95% confidence interval, 1.02-1.11). Conclusions: Despite the absence of randomized controlled trials, the level of use of rhythm-control and anticoagulation treatment for POAF is rising. High-quality trials are needed urgently to determine whether these interventions are safe and effective in this population.

Instituciones: Universidad Peruana Cayetano Heredia