Dexmedetomidine protects against new-onset AF in critically ill patients

The use of dexmedetomidine in the intensive care unit (ICU) appears to lower the risk of new-onset atrial fibrillation (AF) in patients, according to a study.

For the propensity score–matched cohort study, researchers used the Medical Information Mart for Intensive Care-IV database, which includes records of patients admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, US. A total of 22,237 adult patients (mean age 65.9 years, 55.5 percent men) in the ICU were identified.

Following propensity score matching, a final cohort consisting of 8,015 patients (mean age 61.0 years, 65.4 percent men) were included in the analysis. Of these, 2,106 patients received dexmedetomidine within 48 hours after ICU admission (treatment group).

The primary outcome of new-onset AF within 7 days of ICU admission occurred less frequently in the treatment group than in the control group of patients who did not receive dexmedetomidine (17.6 percent vs 22.4 percent). The use of the drug was associated with a 20-percent reduction in the risk of new-onset AF (hazard ratio [HR], 0.80, 95 percent confidence interval [CI], 0.71–0.90).

Median length of stay in the ICU was significantly longer in the treatment group than in the control group (4.0 vs 3.5 days; p<0.001), as was the median length of hospital stay (10.0 vs 8.8 days; p<0.001). However, dexmedetomidine was associated with a more than 50-percent reduction in the risk of in-hospital mortality (deaths, 6.3 percent vs 12.8 percent; HR, 0.43, 95 percent CI, 0.36–0.52).

The present data warrant further evaluation of the benefits of dexmedetomidine use in ICU in a randomized clinical trial.