Conclusions | Pharmacological and non-pharmacological treatments and outcomes for new-onset atrial fibrillation in ICU patients: the CAFE scoping review and database analyses

Pharmacological and non-pharmacological treatments and outcomes for new-onset atrial fibrillation in ICU patients: the CAFE scoping review and database analyses · Conclusions

Conclusions

Implications for service provision

There are insufficient data available to make firm recommendations for service provision in the management of NOAF identified during an ICU admission.

Suggested research priorities

Research priorities were suggested by the expert panel following data review (following the National Institute for Health and Care Excellence Research Recommendations Process and Methods Guide;98 see Appendix 8). NOAF during an ICU stay is associated with substantially increased mortality, after correction for associated risk factors. Both amiodarone and beta-blockers are commonly used, but have significant side effects. Whether or not one is superior to the other has not been demonstrated. A RCT of amiodarone compared with beta-blockers for the management of NOAF in critically ill patients should be undertaken (see Appendix 8, Table 36).

The evidence for or against anticoagulation for patients who develop NOAF in an ICU is very scarce. The risk of thromboembolism is increased in those who develop NOAF compared with those who do not develop NOAF, even when corrected for known risk factors. However, current risk stratification tools have not been validated in the ‘NOAF during ICU population’ and do not take into account whether or not ICU treatments may affect future outcome. Whether or not there are subgroups of patients who develop NOAF while in an ICU who may benefit from long-term anticoagulation is unknown. Studies should be undertaken to create risk stratification tools or to investigate whether or not current tools are applicable to the ‘NOAF during ICU population’ to identify patients sufficiently at risk of future thromboembolism to merit consideration of anticoagulation (see Appendix 8, Table 37).

Readmissions with heart failure and thromboembolism increase over the 5 years following an episode of NOAF while in an ICU, particularly in the first year. Whether these events are driven by persistent left ventricular dysfunction and/or AF is unknown. A prospective cohort study to demonstrate the incidence of AF and/or left ventricular dysfunction at hospital discharge and at 3 months following development of NOAF should be undertaken (see Appendix 8, Table 38).

Attribution. Jonathan Bedford; Laura Drikite; Mark Corbett; James Doidge; Paloma Ferrando-Vivas; Alistair Johnson et al. (2021). Pharmacological and non-pharmacological treatments and outcomes for new-onset atrial fibrillation in ICU patients: the CAFE scoping review and database analyses. NIHR Journals Library. Copyright © 2021 Bedford et al. This work was produced by Bedford et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. Licensed under CC BY 4.0. NCBI Bookshelf NBK575620. CC BY 4.0. Original source ↗. Text reproduced from the Bookshelf XML without changing wording; figures, images and supplements are not reproduced.