Early Postoperative Atrial Fibrillation Tied to Increased Long-Term Mortality After Cardiac Surgery: Study
Researchers have found in a new study that early postoperative atrial fibrillation (POAF) following cardiac surgery is significantly associated with higher long-term mortality, though not with an increased risk of late stroke, after adjusting for demographic and clinical factors.
Early postoperative atrial fibrillation (early-POAF) is the most common complication after cardiac surgery. Although prior studies have demonstrated an association between early-POAF and late outcomes, it is questionable whether these long-term adverse events result from early-POAF or from comorbidities that underlie the development of early-POAF. Therefore, the aim of this study was to investigate the association of early-POAF with late mortality and stroke after adjustment for age and cardiovascular comorbidities.
A systematic search was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without early-POAF. Articles presenting Kaplan–Meier were included for a pooled analysis of late mortality (primary outcome) and stroke (secondary outcome). Individual time-to-event data were reconstructed from the Kaplan–Meier curves and incorporated into a multivariable mixed-effects Cox model. Results: In total, 33 studies were included in the analysis for late mortality (131 031 patients) and 10 studies in the analysis for late stroke (42 042 patients).
Overall, 36 991 patients had early-POAF with a pooled incidence of 31.5% (95% CI: 27.7 to 35.6%). Unadjusted analysis showed that early-POAF was significantly associated with late mortality (Hazard Ratio [HR] = 1.62, 95%CI: 1.58–1.67, P < 0.001) and late stroke (HR = 1.72, 95%CI: 1.61–1.85, P < 0.001). Early-POAF was significantly associated with late mortality (adjusted HR = 1.19, 95% CI: 1.07–1.33, P = 0.002), but not with late stroke (adjusted HR = 1.14, 95% CI: 0.96–1.35, P = 0.122) after adjustment for age, comorbidities, surgery type, and the random effects term. Early-POAF after cardiac surgery is significantly associated with late mortality, but not with late stroke, after adjustments for age, sex, cardiovascular comorbidities, and type of surgery.
Reference:
Kawczynski, M.J., van der Heijden, C.A., Maessen, J.G. et al. Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis. J Cardiothorac Surg 20, 265 (2025). https://doi.org/10.1186/s13019-025-03504-9
