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New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs.

Almassi GH, Hawkins RB, Bishawi M, Shroyer AL, Hattler B, Quin JA, Collins JF, Bakaeen FG, Ebrahimi R, Grover FL, Wagner TH, Veterans Affairs Randomized On/Off Bypass Follow-up Study (ROOBY-FS) Group. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. The Journal of Thoracic and Cardiovascular Surgery. 2021 May 1; 161(5):1803-1810.e3.

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OBJECTIVE: The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs "Randomized On/Off Bypass Follow-up Study" compared 5-year outcomes and costs between patients with and without POAF. METHODS: Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n  =  551) and patients without POAF (n  =  1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of .01 was required to identify statistical significance. RESULTS: Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P  =  .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P  =  .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. CONCLUSIONS: No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years.

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