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 Although the heart flutters and fibrillation may result from short
term stress associated with having surgery, they could also be a
sign of undiagnosed vulnerability to stroke and should be heeded,
researchers say.
“We want patients and clinicians to be aware that having (atrial
fibrillation) after surgery does have long term implications and has
to be followed up on after surgery is over,” the study’s senior
author Dr. Hooman Kamel said.
Kamel, from Weill Cornell Medical College in New York City, and his
team found the risk of strokes among people who developed irregular
heart rhythms while hospitalized for surgeries unrelated to their
hearts was about double the risk of people who didn’t develop the
condition.
Atrial fibrillation is the most common form of irregular heartbeat,
affecting an estimated 2.7 million people in the U.S., according to
the Centers for Disease and Control and Prevention.
Among people with chronic atrial fibrillation, which causes
irregular blood flow, the condition can lead to clots that increase
the risk of ischemic stroke and patients often take blood thinners
to reduce clotting.
Ischemic strokes are caused by an interruption in the flow of blood
to the brain, usually by clot.
Less is known about the long-term stroke risk of surgery patients
who develop the atrial fibrillation as a short-term response to the
added stress on the body, write Kamel and his coauthors in JAMA, the
journal of the American Medical Association.
For the study, the researchers analyzed data from over 1.7 million
people who had surgeries at California hospitals between 2007 and
2011.
Of those, 24,711 were diagnosed with atrial fibrillation during
their hospital stays and 13,952 had ischemic strokes in the few
years after discharge.
Among patients whose surgeries were not related to the heart, the
researchers found that about 1.5 percent of the patients newly
diagnosed with atrial fibrillation in the hospital had strokes in
the year following their surgeries. That compared to about 0.4
percent of those who didn’t develop fibrillation while hospitalized.
Among patients who were having heart surgeries, about 1 percent of
those who developed atrial fibrillation went on to have strokes
during the following year, compared to about 0.8 percent of those
who didn’t develop the irregular heart rhythm.
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After adjusting for factors that may influence the patients’ stroke
risk – such as age, sex and heart disease, the researchers found
those who developed atrial fibrillation during their hospital stays
for a non-heart-related surgery had a two-fold increased risk of
having strokes during the following year.
Among heart surgery patients, developing atrial fibrillation during
the hospital stay was tied to about a 30 percent increased risk of
stroke.
It's not known why the increase in risk would be different between
non-heart surgery and heart surgery patients, but Kamel said there
are a number of possibilities.
For example, heart surgery patients may enter with an increased
stroke risk and may be watched more carefully for signs of stroke.
"Rather than viewing the occurrence of (atrial fibrillation) after
surgery as a temporary condition, I think it needs to be clearly
documented and communicated with the patient,” Kamel said.
Patients need to be educated about the condition and their doctors
need to be told about the development so they can follow up and
create treatment plans to reduce the risk of stroke, he added.
SOURCE: http://bit.ly/VfhFFH JAMA,
online August 12, 2014.
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