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

E. Anne Russell, Warren F. Walsh, Lavinia Tran, Robert Tam, Christopher M. Reid, Alex Brown, Jayme S. Bennetts, Robert A. Baker, Graeme P. Maguire

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

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 comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2–1.7) and long term (HR 1.5, 95% CI 1.3–1.7) 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.

Original languageEnglish
Pages (from-to)100-105
Number of pages6
JournalInternational Journal of Cardiology
Volume227
DOIs
Publication statusPublished - 15 Jan 2017

Keywords

  • Atrial fibrillation
  • Cardiac surgery
  • Valve disease surgery
  • Valvular heart disease

Cite this

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title = "The burden and implications of preoperative atrial fibrillation in Australian heart valve surgery patients",
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 comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95{\%} CI 1.2–1.7) and long term (HR 1.5, 95{\%} CI 1.3–1.7) 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.",
keywords = "Atrial fibrillation, Cardiac surgery, Valve disease surgery, Valvular heart disease",
author = "Russell, {E. Anne} and Walsh, {Warren F.} and Lavinia Tran and Robert Tam and Reid, {Christopher M.} and Alex Brown and Bennetts, {Jayme S.} and Baker, {Robert A.} and Maguire, {Graeme P.}",
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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.; Maguire, Graeme P.

In: International Journal of Cardiology, Vol. 227, 15.01.2017, p. 100-105.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The burden and implications of preoperative atrial fibrillation in Australian heart valve surgery patients

AU - Russell, E. Anne

AU - Walsh, Warren F.

AU - Tran, Lavinia

AU - Tam, Robert

AU - Reid, Christopher M.

AU - Brown, Alex

AU - Bennetts, Jayme S.

AU - Baker, Robert A.

AU - Maguire, Graeme P.

PY - 2017/1/15

Y1 - 2017/1/15

N2 - 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 comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2–1.7) and long term (HR 1.5, 95% CI 1.3–1.7) 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.

AB - 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 comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2–1.7) and long term (HR 1.5, 95% CI 1.3–1.7) 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.

KW - Atrial fibrillation

KW - Cardiac surgery

KW - Valve disease surgery

KW - Valvular heart disease

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U2 - 10.1016/j.ijcard.2016.11.070

DO - 10.1016/j.ijcard.2016.11.070

M3 - Article

VL - 227

SP - 100

EP - 105

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -