New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs

Content Provider	Scilit
Author	Almassi, G. Hossein Hawkins, Robert B. Bishawi, Muath Shroyer, A. Laurie Hattler, Brack Quin, Jacquelyn A. Collins, Joseph F. Bakaeen, Faisal G. Ebrahimi, Ramin Grover, Frederick L. Wagner, Todd H.
Copyright Year	2019
Description	Journal: Journal of Thoracic and Cardiovascular Surgery Objective The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs "Randomized On/Off Bypass Follow-up Study" compared 5-year outcomes and costs between patients with and without POAF. Methods Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n = 551) and patients without POAF (n = 1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of ≤.01 was required to identify statistical significance. Results Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P = .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P = .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. Conclusions No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years.
Related Links	http://www.jtcvs.org/article/S0022522319327746/pdf
ISSN	00225223
e-ISSN	1097685X
DOI	10.1016/j.jtcvs.2019.10.150
Journal	Journal of Thoracic and Cardiovascular Surgery
Issue Number	5
Volume Number	161
Language	English
Publisher	Elsevier BV
Publisher Date	2019-11-14
Access Restriction	Open
Subject Keyword	Journal: Journal of Thoracic and Cardiovascular Surgery Medical Informatics Atrial Fibrillation Treatment Outcome Costs and Cost Analysis Acute Myocardial Infarction Coronary Artery Bypass Grafting Confidence Interval Major Adverse Cardiovascular Events Postoperative Atrial Fibrillation Randomized On Vs Off Bypass Rooby Follow-up Study
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine