In a nationwide cohort, researchers wanted to see how AF affected the risk of adverse outcomes after noncardiac surgery.

From 2015 to 2019, they identified Medicare members hospitalized for noncardiac surgery and separated the study cohort into two groups: those with and without AF. Noncardiac surgery was divided into the following categories: vascular, thoracic, general, genitourinary, gynecological, orthopedics and neurosurgery, breast, head and neck, and transplant. They employed propensity score matching on precise age, gender, race, urgency, and type of operation, the revised cardiac risk index (RCRI), the CHA2DS2-VASc score, and a strict restriction on additional comorbidities. The trial outcomes were 30-day death, stroke, myocardial infarction, and heart failure. They looked at how AF, in addition to RCRI, may predict adverse outcomes following noncardiac surgery. The research comprised 8,635,758 participants who had noncardiac surgery (16.4% with AF). Patients with AF were older, more likely to be men, and had a greater comorbidity rate. 

After propensity score matching, AF was associated with a higher risk of mortality (OR: 1.31; 95% CI: 1.30-1.32), heart failure (OR: 1.31; 95% CI: 1.30-1.33), stroke (OR: 1.40; 95% CI: 1.37-1.43), and a lower risk of myocardial infarction (OR: 1.40; 95% CI: 1.37-1.43) and a lower risk of myocardial infarction (OR: 0.81; 95% CI: 0.79-0.82). Subgroup analysis by gender, race, type of surgery, and all RCRI and CHA2DS2-VASc score strata yielded consistent results. AF increased RCRI’s discriminative capacity (C-statistic 0.73 to 0.76).

Pre-existing AF is related to worse postoperative outcomes following NCS. 

Reference: jacc.org/doi/10.1016/j.jacc.2022.04.021