Long‐term risk of heart failure in patients with postoperative atrial fibrillation following non‐cardiac surgery: Insights from a nationwide cohort

Aims Atrial fibrillation (AF) is associated with heart failure (HF). However, it is unclear if postoperative AF (POAF) following non‐cardiac surgery differs from non‐surgical AF in terms of the risk of HF. We compared the long‐term rate of incident HF in patients developing new‐onset POAF following non‐cardiac surgery with patients who did not develop POAF following non‐cardiac surgery and patients with non‐surgical non‐valvular AF (NVAF). Methods and results Using Danish nationwide registries, all patients aged ≥30 years who developed POAF following non‐cardiac surgery (1996–2020) were identified and matched in a 1:3 ratio by age, sex, surgery type (only for the surgery group), selected comorbidities, and inclusion year with patients without POAF following non‐cardiac surgery and individuals with NVAF, respectively. A total of 2270 patients with POAF were matched with 6810 patients without POAF following non‐cardiac surgery, and 1846 patients with POAF were matched with 5538 patients with NVAF. The median follow‐up was 7.2 years. Compared with patients without POAF, those with POAF had a higher associated long‐term rate of incident HF (2.6 vs. 1.2 events per 100 person‐years; adjusted hazard ratio [HR] 2.39, 95% confidence interval [CI] 2.06–2.78). Compared with individuals with NVAF, patients with POAF did not have a significantly different rate of incident HF (2.7 vs. 3.0 events per 100 person‐years; adjusted HR 0.89, 95% CI 0.78–1.03). Conclusion Patients with new‐onset POAF following non‐cardiac surgery had a higher associated long‐term rate of incident HF compared to those without POAF, with no significant difference in the rate of incident HF when compared to patients with NVAF.