Post-operative AF occurs in up to 40% of patients undergoing heart surgery and 2% of patients undergoing non-cardiac surgery. Doctors have tended to view it as a benign event, triggered by the stress of the surgery. However, evidence is emerging that post-operative AF is linked to longer term problems such as stroke and death from any cause, although, until now, there has been limited evidence regarding its association with subsequent heart failure.
For the current, retrospective study, the researchers collected data on health claims from 2016 to 2018 for discharges from acute care hospitals across 11 states in the U.S.. Patients were aged over 18 and they were followed up for an average (median) of 1.7 years. The researchers adjusted their analyses to account for factors that could affect the results such as age, sex, race, insurance status, medical history and body mass index.
The strength of this study is its large size. Limitations include the fact that it is an observational study, and therefore, cannot prove that post-operative AF causes heart failure, only that it is associated with it. The study relies on administrative claims data and medical codes to identify medical conditions; it lacks more detailed information like management strategies for post-operative AF, and on the function and size of the left ventricle, which could affect the likelihood of developing AF.
The researchers hope to conduct further studies to understand the underlying mechanism and to investigate ways of preventing future hospitalizations for heart failure among patients who develop post-operative AF.
In the conclusion to the paper, the researchers write, “In the meantime, clinicians should be aware that POAF [post-operative AF] may be a harbinger of HF.”
In an editorial to accompany the paper, Dr. Melissa Middeldorp and Professor Christine Albert, both from the Smidt Heart Institute at Cedars-Sinai, California, U.S., write, “These data add to a growing body of literature suggesting that POAF is not just a transient response to surgery but may be reflective of underlying atrial and myocardial structural changes that not only predispose to the acute AF event but to other potentially related adverse cardiovascular events, such as HF hospitalization.”
They write that more information and a better understanding of the mechanisms involved in placing people at greater risk of AF and post-operative heart failure is needed in order to reduce hospitalization and deaths after surgery. This will require further studies.
“With a greater understanding of patients’ full risk factor profile, we may advocate for early aggressive intervention at the initial manifestation of POAF, to improve outcomes and reduce rehospitalization following cardiac and non-cardiac surgery,” they conclude.
The study was published in the European Heart Journal.
Source: European Society of Cardiology
Source: Healthcare in Europe