Risk of thromboembolism in patients developing critical illness-associated atrial fibrillation

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Although common, the long-term significance of ­developing atrial fibrillation (AF) during a period of critical illness is unclear. We undertook a retrospective cohort analysis to ­assess the rate of thromboembolism (TE) in patients ­developing atrial fibrillation de novo during admission to our intensive care unit. In total, 1,955 patients were followed up (­maximum follow-up 1,276 days) for the occurrence of TE, of which 220 (11.3%) had developed AF or atrial flutter during their critical care admission. There were 11 TE events among the patients with new AF (0.053 events per patient-year), compared with 18 in the non-AF group (0.0059 events per patient-year). The unadjusted hazard ratio for TE in patients developing new AF compared with those not developing AF was 8.09 (95% CI 3.08–17.19, p<0.001). In patients admitted to critical care, the development of AF appears to be associated with a significantly increased risk of subsequent thromboembolism.

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