Long-term outcomes of postoperative atrial fibrillation after cardiac surgery: Results from 19,000 patients.

Abstract

Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, yet contemporary procedure-specific data on its incidence, temporal trends, and long-term prognostic impact are limited. We conducted a retrospective cohort study of consecutive adult patients undergoing cardiac surgery between January 2010 and April 2024 at a single quaternary referral center. Patients with prior atrial fibrillation, concomitant maze procedures, or death within 30 days were excluded. POAF was defined as any new-onset AF during the index hospitalization up to 30 days. Outcomes were assessed using multivariable Cox regression, restricted mean survival time (RMST), with adjustment for demographic, clinical, and procedural covariates. A total of 19,316 patients undergoing cardiac surgery, including isolated coronary artery bypass grafting (CABG), valve surgery, aortic surgery, or multicomponent procedures were included. POAF occurred in 6333 patients (32.8%). Incidence varied by procedure: combined CABG and valve 48.0%, CABG and aortic 46.3%, isolated valve 36.9% to 37.0%, and isolated CABG 29.4%. Overall POAF incidence declined by 3.7% annually (95% CI, 2.9%-4.5%). After adjustment, POAF was associated with reduced long-term survival (ΔRMST 0.45 years lost over 10 years; 95% CI, 0.36-0.55), greatest in multicomponent procedures (0.64 years lost) and CABG (0.47 years lost). POAF was also associated with higher heart failure hospitalization at 10 years (absolute difference, 5.8%; 95% CI, 4.1%-7.5%) but not with stroke in competing risk models. Although the incidence of POAF has declined over time, it remains common and is associated with significant long-term adverse outcomes, including reduced survival and increased heart failure hospitalization.