• Pablo Alonso-Coello, Deborah Cook, Shou Chun Xu, Alben Sigamani, Otavio Berwanger, Soori Sivakumaran, Homer Yang, Denis Xavier, Luz Ximena Martinez, Pedro Ibarra, Purnima Rao-Melacini, Janice Pogue, Kelly Zarnke, Pilar Paniagua, Jack Ostrander, Salim Yusuf, P J Devereaux, and POISE Investigators.
• From the *Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Departments of †Medicine and Clinical Epidemiology and ‡Biostatistics, McMaster University, Hamilton, Ontario, Canada; §Hypertension League Institute, Beijing, China; ‖Department of Clinical Research, Narayana Hrudyalaya Limited, Bangalore, India; ¶Research Institute HCor (Heart Hospital-Hospital do Coracao), Sao Paulo, Brazil; #Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; **Department of Anaesthesia, University of Ottawa, Ontario, Canada; ††St John's Medical College and St John's Research Institute, Bangalore, India; ‡‡Department of Medicine, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia; §§Department of Anaesthesia, Clinica Reina Sofia, Bogota, Colombia; ‖‖Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; ¶¶Department of Medicine, University of Calgary, Alberta, Canada; ##Department of Anesthesiology, Hospital de la Sta Creu i Sant Pau, Barcelona, Spain; ***Department of Medicine, Grey Bruce Health Sciences, Owen Sound, Ontario, Canada; and †††Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
• Anesth. Analg. 2017 Jul 1; 125 (1): 162-169.

BackgroundDespite the frequency of new clinically important atrial fibrillation (AF) after noncardiac surgery and its increased association with the risk of stroke at 30 days, there are limited data informing their prediction, association with outcomes, and management.MethodsWe used the data from the PeriOperative ISchemic Evaluation trial to determine, in patients undergoing noncardiac surgery, the association of new clinically important AF with 30-day outcomes, and to assess management of these patients. We also aimed to derive a clinical prediction rule for new clinically important AF in this population. We defined new clinically important AF as new AF that resulted in symptoms or required treatment. We recorded an electrocardiogram 6 to 12 hours postoperatively and on the 1st, 2nd, and 30th days after surgery.ResultsA total of 211 (2.5% [8351 patients]; 95% confidence interval, 2.2%-2.9%) patients developed new clinically important AF within 30 days of randomization (8140 did not develop new AF). AF was independently associated with an increased length of hospital stay by 6.0 days (95% confidence interval, 3.5-8.5 days) and vascular complications (eg, stroke or congestive heart failure). The usage of an oral anticoagulant at the time of hospital discharge among patients with new AF and a CHADS2 score of 0, 1, 2, 3, and ≥4 was 6.9%, 10.2%, 23.0%, 9.4%, and 33.3%, respectively. Two independent predictors of patients developing new clinically important AF were identified (ie, age and surgery). The prediction rule included the following factors and assigned weights: age ≥85 years (4 points), age 75 to 84 years (3 points), age 65 to 74 years (2 points), intrathoracic surgery (3 points), major vascular surgery (2 points), and intra-abdominal surgery (1 point). The incidence of new AF based on scores of 0 to 1, 2, 3 to 4, and 5 to 6 was 0.5%, 1.0%, 3.1%, and 5.3%, respectively.ConclusionsAge and surgery are independent predictors of new clinically important AF in the perioperative setting. A minority of patients developing new clinically important AF with high CHADS2 scores are discharged on an oral anticoagulant. There is a need to develop effective and safe interventions to prevent this outcome and to optimize the management of this event when it occurs.

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