The burden and implications of preoperative atrial fibrillation in Australian heart valve surgery patients

Russell, E. Anne, Walsh, Warren F., Tran, Lavinia, Tam, Robert, Reid, Christopher M., Brown, Alex, Bennetts, Jayme S., Baker, Robert A., and Maguire, Graeme P. (2017) The burden and implications of preoperative atrial fibrillation in Australian heart valve surgery patients. International Journal of Cardiology, 227. pp. 100-105.

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Abstract

Background: Atrial fibrillation (AF) is the most common preoperative arrhythmia in heart valve surgery patients and its prevalence is rising. This study aims to investigate the impact of AF on valve surgery early complications and survival and on valve disease of different aetiologies and populations with particular reference to Indigenous Australians with rheumatic heart disease (RHD).

Methods: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to determine the association between preoperative AF and valve surgery outcome. Its association with demographics, co-morbidities, preoperative status and short and long term outcome was assessed.

Results: Outcome of 1594 RHD and 19,029 non-RHD-related surgical procedures was analysed. Patients with preoperative AF were more likely to be older, female, Indigenous, to have RHD and to bear a greater burden of co morbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4,)5% CI 12-17) and long term (HR 1.5,95% CII.3-1.7) survival was inferior for patients with non-RHD preoperative AF but was no different for Indigenous and non-Indigenous Australians with RHD.

Conclusions: In this prospective Australian study, patients with valve disease and preoperative AF had inferior short and long term survival. This was particularly the case for patients with non-RHD valve disease. Earlier intervention or more aggressive AF management should be investigated as mechanisms for enhancing postoperative outcomes. This may influence treatment choice and the need for ongoing anticoagulation. (C) 2016 Elsevier Ireland Lid. All rights reserved.

Item ID: 50395
Item Type: Article (Research - C1)
ISSN: 1874-1754
Keywords: atrial fibrillation, valvular heart disease, valve disease surgery, cardiac surgery
Funders: National Health and Medical Research Council (NHMRC), Viertel Senior Medical Research Fellowship, Victorian Government (VG), Department of Health Victoria, Health Administration Corporation, Clinical Excellence Commission NSW
Projects and Grants: NHMRC Postgraduate Scholarship, NHMRC Practicioner Fellowship, NHMRC Senior Research Fellowship, NHMRC Grant ID: 1044897, NHMRC Grant ID: 1080401, VG OIS Program
Date Deposited: 20 Sep 2017 08:34
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 80%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 20%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 80%
92 HEALTH > 9203 Indigenous Health > 920301 Aboriginal and Torres Strait Islander Health - Determinants of Health @ 20%
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