Predictors, Prognosis, and Management of New Clinically Important Atrial Fibrillation After Noncardiac Surgery: A Prospective Cohort Study.

BACKGROUND: Despite the frequency of new clinically important atrial fibrillation (AF) after noncardiac surgery and its increased association with the risk of stroke at 30 days, there are limited data informing their prediction, association with outcomes, and management. METHODS: We used the data from the PeriOperative ISchemic Evaluation trial to determine, in patients undergoing noncardiac surgery, the association of new clinically important AF with 30-day outcomes, and to assess management of these patients. We also aimed to derive a clinical prediction rule for new clinically important AF in this population. We defined new clinically important AF as new AF that resulted in symptoms or required treatment. We recorded an electrocardiogram 6 to 12 hours postoperatively and on the 1st, 2nd, and 30th days after surgery. RESULTS: A total of 211 (2.5% [8351 patients]; 95% confidence interval, 2.2%-2.9%) patients developed new clinically important AF within 30 days of randomization (8140 did not develop new AF). AF was independently associated with an increased length of hospital stay by 6.0 days (95% confidence interval, 3.5-8.5 days) and vascular complications (eg, stroke or congestive heart failure). The usage of an oral anticoagulant at the time of hospital discharge among patients with new AF and a CHADS2 score of 0, 1, 2, 3, and ≥4 was 6.9%, 10.2%, 23.0%, 9.4%, and 33.3%, respectively. Two independent predictors of patients developing new clinically important AF were identified (ie, age and surgery). The prediction rule included the following factors and assigned weights: age ≥85 years (4 points), age 75 to 84 years (3 points), age 65 to 74 years (2 points), intrathoracic surgery (3 points), major vascular surgery (2 points), and intra-abdominal surgery (1 point). The incidence of new AF based on scores of 0 to 1, 2, 3 to 4, and 5 to 6 was 0.5%, 1.0%, 3.1%, and 5.3%, respectively. CONCLUSIONS: Age and surgery are independent predictors of new clinically important AF in the perioperative setting. A minority of patients developing new clinically important AF with high CHADS2 scores are discharged on an oral anticoagulant. There is a need to develop effective and safe interventions to prevent this outcome and to optimize the management of this event when it occurs.

[Impact of the new definitions in the prevalence of the metabolic syndrome in an adult population at Bucaramanga, Colombia]. / Impacto de las nuevas definiciones en la prevalencia del síndrome metabólico en una población adulta de Bucaramanga, Colombia.

INTRODUCTION: The prevalence of metabolic syndrome depends on the criteria used for its classification. Three criteria in common use are those from International Diabetes Federation (IDF), the Adult Treatment Panel (ATP-III) or its update (ATP-IIIa). OBJECTIVE: The prevalence statistic for generated metabolic syndrome was compared on the basis of each of the three criteria in an adult population. MATERIALS AND METHODS: The sample consisted of 155 teachers and employees in the school of medicine. The average age was 40.9; 54.2% were men. The three criteria were applied and the prevalences were compared with the Wilcoxon test and Cohen's kappa. RESULTS: Metabolic syndrome prevalence generated by each criterion was as follows: ATP-III was 12.3% (95%CI 7.5-18.5), ATP-IIIa was 34.8% (95%CI 27.4-42.9) and IDF 32.9% (95%CI 25.6--40.9). The prevalence indicated by ATP-III was lower than the ATP-IIIa or IDF prevalences (p < 0,001); however those of ATPIII-a and IDF were similar (p=0,083). Poor agreement was seen between ATP-III and ATP-IIIa (k=0.414, IC95% 0.409-0.420), and between ATP-III and IDF (k=0.374, IC95% 0.368-0.379); however, very good agreement was obtained between ATP-IIIa and IDF (k=0.957, IC95% 0.950-0.963). CONCLUSION: The new definitions for metabolic syndrome, ATP-IIIa and IDF, increase the prevalence statistic by three times. This occurred despite the inclusion in IDF of an obesity factor in the criteria set.

Impacto de las nuevas definiciones en la prevalencia del síndrome metabólico en una población adulta de Bucaramanga, Colombia / Impact of the new definitions in the prevalence of the metabolic syndrome in an adult population at Bucaramanga, Colombia

Introducción. La prevalencia de síndrome metabólico depende de los criterios de clasificación empleados, como son los de la International Diabetes Federation y el Adult Treatment Panel o su modificación.Objetivo. Comparar la prevalencia del síndrome metabólico generada por cada una de las tres definiciones en una población de adultos. Materiales y métodos. Se estudiaron 155 personas (54,2 por ciento varones, edad promedio de 40,9 años). Se aplicaron las tres definiciones y se comparó la prevalencia con la prueba de Wilcoxon y la concordancia con kappa de Cohen. Resultados. La prevalencia de síndrome metabólico según el Adult Treatment Panel-III (ATP-III) fue 12,3 por ciento (IC95 por ciento 7,5-18,5), según el Adult Treatment Panel-IIIa (ATP-IIIa), 34,8 por ciento (IC95 por ciento 27,4-42,9) y según la International Diabetes Federation (IDF), 32,9 por ciento (IC95 por ciento 25,6-40,9). La prevalencia por ATP-III es inferior a la vista por ATP-IIIa e IDF (p<0,001), pero entre estas dos últimas es similar (p=0,083). Hay pobre concordancia entre ATP-III y ATP-IIIa (k=0,414, IC95 por ciento 0,409-0,420), y entre ATP-III e IDF (k=0,374, IC95 por ciento 0,368–0,379), pero muy buena entre ATP-IIIa e IDF (k=0,957, IC95 por ciento 0,950–0,963). Conclusión. Las nuevas definiciones para el síndrome metabólico (ATP-IIIa e IDF) aumentan tres veces la prevalencia del diagnóstico, sin encontrar diferencias entre ellas, a pesar de que la última organización incluye la obesidad central como un criterio necesario para el diagnóstico, cuando en la primera no se hace igual ponderación.

Introduction. The prevalence of metabolic syndrome depends on the criteria used for its classification. Three criteria in common use are those from International Diabetes Federation (IDF), the Adult Treatment Panel (ATP-III) or its update (ATP-IIIa). Objective. The prevalence statistic for generated for metabolic syndrome was compared for on the basis of each of the three criteria. Materials and methods. The sample consisted of 155 teachers and employees in the school of medicine. The average age was 40.9; 54.2% were men. The three criteria were applied and the prevalences were compared with the Wilcoxon test and Cohen’s kappa. Results. Metabolic syndrome prevalence generated by each criterion was as follows: ATP-III was 12.3% (95%CI 7.5-18.5), ATP-IIIa was 34.8% (95%CI 27.4-42.9) and IDF 32.9% (95%CI 25.6--40.9). The prevalence indicated by ATP-III was lower than the ATP-IIIa or IDF prevalances (p < 0,001); however those of ATPIII-a and IDF were similar (p=0,083). Poor agreement was seen between ATP-III and ATP-IIIa (k=0.414, IC95% 0.409-0.420), and between ATP-III and IDF (k=0.374, IC95% 0.368-0.379); however, very good agreement was obtained between ATP-IIIa and IDF (k=0.957, IC95% 0.950-0.963). Conclusion. The new definitions for metabolic syndrome, ATP-IIIa and IDF, increase the prevalence statistic by three times. This occurred despite the inclusion in IDF of an obesity factor in the criteria set.