Perioperative atrial fibrillation linked to increased long-term risk of stroke

1. Perioperative atrial fibrillation was associated with an increased risk of ischemic stroke 1 year after hospitalization.   

2. Noncardiac surgery was associated with a greater long-term stroke risk than cardiac surgery.  

Evidence Rating Level: 1 (Excellent) 

Study Rundown: While chronic atrial fibrillation (AF) is known to increase stroke risk, the risk of transient perioperative atrial fibrillation, one of the most common perioperative cardiac arrhythmias, remains unknown. Prior perioperative AF studies have focused on the immediate risk of stroke and have produced limited data on long-term stroke risk associated with noncardiac surgeries. In contrast, this study examined the long-term risk of ischemic stroke after perioperative atrial fibrillation associated with both cardiac and non-cardiac studies in a large patient population over 4 years.

This study demonstrated that the long-term risk of perioperative stroke was increased in cases of both cardiac and non-cardiac surgery, but that the degree of this association was greater for non-cardiac studies. Prior studies have similarly shown that perioperative AF in cardiac surgeries occurs primarily as isolated events, possibly related to the physiological stress placed on the myocardium by cardiac surgery. However, the results of this study are limited by the inability to control for certain factors that may contribute to stroke risk, such as the length of the perioperative AF episodes and the lack of data on anticoagulant medication use. Future research should focus on determining proper medication strategies to decrease risk of long-term risk of stroke in patients with perioperative AF as well as improving monitoring in patients deemed at an increased risk of such thromboembolic events.

Click to read the study, published today in JAMA

Relevant Reading: Stroke severity in atrial fibrillation: the Framingham Study

In-Depth [retrospective cohort]: This retrospective study used administrative claims data on 1,729,360 patients hospitalized for surgery in California between 2007-2011. Perioperative AF was seen in 24,711 patients (1.43%). Perioperative AF was seen in 16.10% of cardiac surgeries and 0.78% of other types of surgeries. However, the association with stroke was stronger for non-cardiac surgeries (HR 2.0, 95% CI 1.7-2.3) versus cardiac surgery (HR 1.3, 95% CI 1.1-1.6). At 1 year after hospitalization for noncardiac surgery cumulative rates of stroke were 1.47% (95% CI, 1.24%-1.75%).  in those with perioperative AF and 0.36% (95% CI, 0.35%-0.37%) in those without AF. At 1 year after cardiac surgery, rates of stroke were 0.99% (95% CI, 0.81%-1.20%) in those with perioperative AF and 0.83% (95% CI, 0.76-%-0.91%) in those without AF.

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Image: PD 

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