New-onset atrial fibrillation in critically ill adult patients—an SSAI clinical practice guideline
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New-onset atrial fibrillation in critically ill adult patients—an SSAI clinical practice guideline. / Andreasen, Anne Sofie; Wetterslev, Mik; Sigurdsson, Martin Ingi; Bove, Jeppe; Kjærgaard, Jesper; Aslam, Tayyba Naz; Järvelä, Kati; Poulsen, Mette; De Geer, Lina; Agarwal, Arnav; Kjær, Maj Brit Nørregaard; Møller, Morten Hylander.
In: Acta Anaesthesiologica Scandinavica, Vol. 67, No. 8, 2023, p. 1110-1117.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - New-onset atrial fibrillation in critically ill adult patients—an SSAI clinical practice guideline
AU - Andreasen, Anne Sofie
AU - Wetterslev, Mik
AU - Sigurdsson, Martin Ingi
AU - Bove, Jeppe
AU - Kjærgaard, Jesper
AU - Aslam, Tayyba Naz
AU - Järvelä, Kati
AU - Poulsen, Mette
AU - De Geer, Lina
AU - Agarwal, Arnav
AU - Kjær, Maj Brit Nørregaard
AU - Møller, Morten Hylander
N1 - Funding Information: We are very grateful to the patient representatives Olaf Schroeder, Maria Høpner, Tine Piil Petersen, Michael Piil Petersen, and Kent Bering for being part of the guideline panel. Publisher Copyright: © 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
PY - 2023
Y1 - 2023
N2 - Background: Acute or new-onset atrial fibrillation (NOAF) is the most common cardiac arrhythmia in critically ill adult patients, and observational data suggests that NOAF is associated to adverse outcomes. Methods: We prepared this guideline according to the Grading of Recommendations Assessment, Development and Evaluation methodology. We posed the following clinical questions: (1) what is the better first-line pharmacological agent for the treatment of NOAF in critically ill adult patients?, (2) should we use direct current (DC) cardioversion in critically ill adult patients with NOAF and hemodynamic instability caused by atrial fibrillation?, (3) should we use anticoagulant therapy in critically ill adult patients with NOAF?, and (4) should critically ill adult patients with NOAF receive follow-up after discharge from hospital? We assessed patient-important outcomes, including mortality, thromboembolic events, and adverse events. Patients and relatives were part of the guideline panel. Results: The quantity and quality of evidence on the management of NOAF in critically ill adults was very limited, and we did not identify any relevant direct or indirect evidence from randomized clinical trials for the prespecified PICO questions. We were able to propose one weak recommendation against routine use of therapeutic dose anticoagulant therapy, and one best practice statement for routine follow-up by a cardiologist after hospital discharge. We were not able to propose any recommendations on the better first-line pharmacological agent or whether to use DC cardioversion in critically ill patients with hemodynamic instability induced by NOAF. An electronic version of this guideline in layered and interactive format is available in MAGIC: https://app.magicapp.org/#/guideline/7197. Conclusions: The body of evidence on the management of NOAF in critically ill adults is very limited and not informed by direct evidence from randomized clinical trials. Practice variation appears considerable.
AB - Background: Acute or new-onset atrial fibrillation (NOAF) is the most common cardiac arrhythmia in critically ill adult patients, and observational data suggests that NOAF is associated to adverse outcomes. Methods: We prepared this guideline according to the Grading of Recommendations Assessment, Development and Evaluation methodology. We posed the following clinical questions: (1) what is the better first-line pharmacological agent for the treatment of NOAF in critically ill adult patients?, (2) should we use direct current (DC) cardioversion in critically ill adult patients with NOAF and hemodynamic instability caused by atrial fibrillation?, (3) should we use anticoagulant therapy in critically ill adult patients with NOAF?, and (4) should critically ill adult patients with NOAF receive follow-up after discharge from hospital? We assessed patient-important outcomes, including mortality, thromboembolic events, and adverse events. Patients and relatives were part of the guideline panel. Results: The quantity and quality of evidence on the management of NOAF in critically ill adults was very limited, and we did not identify any relevant direct or indirect evidence from randomized clinical trials for the prespecified PICO questions. We were able to propose one weak recommendation against routine use of therapeutic dose anticoagulant therapy, and one best practice statement for routine follow-up by a cardiologist after hospital discharge. We were not able to propose any recommendations on the better first-line pharmacological agent or whether to use DC cardioversion in critically ill patients with hemodynamic instability induced by NOAF. An electronic version of this guideline in layered and interactive format is available in MAGIC: https://app.magicapp.org/#/guideline/7197. Conclusions: The body of evidence on the management of NOAF in critically ill adults is very limited and not informed by direct evidence from randomized clinical trials. Practice variation appears considerable.
KW - clinical practice guideline
KW - MAGIC
KW - new-onset atrial fibrillation
U2 - 10.1111/aas.14262
DO - 10.1111/aas.14262
M3 - Journal article
C2 - 37289426
AN - SCOPUS:85160109801
VL - 67
SP - 1110
EP - 1117
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 8
ER -
ID: 362890790