Research of more than three million patients, published today in the European Cardiac Journal, found that those who experience an irregular heart rhythm following surgery have a higher chance of being hospitalized with heart failure.

Atrial fibrillation (AF) is an abnormal, and often fast, heart rhythm. The study showed that the risk of hospitalization for heart failure went up for people who got AF after surgery, even if the surgery wasn’t for a heart condition.

Among 76,536 patients who underwent cardiac surgery, 14,365 patients (18.8 percent) developed post-operative AF, and the likelihood of hospitalization for heart failure increased by one-third compared to individuals who did not develop AF. AF developed in 23,763 (0.8 percent) of 2,929,854 patients without a history of heart disease who had surgery for non-heart-related problems, and the likelihood of hospitalization for heart failure increased.

“Our study, which to our knowledge is the largest study to date, shows that post-operative atrial fibrillation is associated with future heart failure hospitalizations,” remarked Dr. Parag Goyal, the study’s first author.

This could imply that atrial fibrillation is a crucial sign of underlying, undiagnosed heart failure, or it could imply that atrial fibrillation itself aids in the progression of heart failure in the future.

“While this study could not specifically address which of these mechanisms are at play, our hope is that this study will inspire future work into exploring the underlying mechanism seen in our important findings.”

The findings of the study clearly demonstrate “that post-operative atrial fibrillation is clearly an important entity that merits attention and incorporation into decision making,” according to the author. 

Most essential, patients and medical professionals should pay more attention to heart failure signs in those who experience post-operative atrial fibrillation. For those who do acquire the illness, more severe therapy may be needed for additional heart failure risk factors like high blood pressure, diabetes, and artery narrowing.

Up to 40% of people having heart surgery and 2% of individuals having non-cardiac surgery get post-operative AF. The stress of the surgery was thought to be the cause, and doctors have a tendency to see it as a benign event. However, evidence is accumulating indicating post-operative AF is associated with long-term complications such as stroke and death from any cause, despite the fact that there has been limited data regarding its association with later heart failure.

For this retrospective study, the researchers got information about health claims from acute care hospitals in 11 US states from 2016 to 2018. Patients who were older than 18 were monitored for a median (mean) of 1.7 years. The researchers accounted for variables such as age, sex, race, insurance status, medical history, and body mass index that could influence the outcomes.

The scale of this study is one of its strengths. The observational nature of the study, which cannot establish causation but merely an association between post-operative AF and heart failure, is one of its limitations. The study uses administrative claims data and medical codes to find medical conditions. It doesn’t have more detailed information, like how to treat AF after surgery or how the size and function of the left ventricle could affect the chance of getting AF.

The purpose of further research is to comprehend the underlying process and to look into ways to keep patients who experience post-operative AF from needing to be hospitalized again for heart failure.

To sum up their findings, the authors write, “In the meantime, clinicians should be aware that POAF [post-operative AF] may be a harbinger of HF.”

“These data add to a growing body of literature suggesting that POAF is not just a transient response to surgery but may be reflective of underlying atrial and myocardial structural changes that not only predispose to the acute AF event but to other potentially related adverse cardiovascular events, such as HF hospitalization,” Dr. Melissa Middeldorp and Professor Christine Albert, both from the Smidt Heart Institute at Cedars-Sinai in California, USA, write in an editorial to accompany the paper.

They write that additional information and a better understanding of the mechanisms that place people at a higher risk for atrial fibrillation (AF) and post-operative heart failure are required to reduce hospitalizations and fatalities following surgery. This will need more research.

To enhance outcomes and decrease rehospitalization following cardiac and non-cardiac surgery, they say, “we may advocate for early aggressive intervention at the initial manifestation of POAF” with a clearer understanding of patients’ overall risk factor profile.

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