Tracking Atrial Fibrillation After Intensive Care Admission

The study aims to determine whether it is feasible to screen patients to detect atrial fibrillation after treatment on an intensive care unit. Patients who develop new onset AF in ICU who have no history of atrial fibrillation prior to ICU admission will be included. These patients will be monitored for atrial fibrillation on the ward post ICU discharge (for 14 days or until hospital discharge), and then again at 3 months post hospital discharge (for 7 days), when they attend the routine post ICU follow up clinic.

In the ICU, this study cohort of patients will be monitored continuously to detect atrial fibrillation. If atrial fibrillation is suspected, this will be confirmed by independent review of a 12-lead ECG. On the ward, post ICU discharge patients will be given a chest patch for continuous cardiac rhythm monitoring designed to detect arrhythmia, which they will wear for 7 days, before a second patch is used for a further 7 days or until hospital discharge, whichever is shortest in duration.

Data relating to past medical history, history of illness requiring ICU admission, subsequent events post ICU discharge and complications post-hospital discharge including hospital readmissions will be collected via hospital records and by patient interview at the follow up clinic.

Patients will attend the ICU follow up clinic at 3 months post hospital discharge. At this time, they will be provided with a new chest patch from the same manufacturer, which they will wear for 7 days.

The primary aim will be to demonstrate the feasibility of monitoring patients for AF occurrence post ICU discharge using a wearable patch device.

Secondary aims will be to identify the proportion of patients who develop NOAF (New onset atrial fibrillation) in ICU who go on to have AF post discharge, as well as documenting the stroke risk, mortality and length of hospital stay in this patient group. This study will guide the design of a larger study investigating AF occurrence and stroke risk in patients post ICU discharge.

Exploratory objectives include to validate a newly designed AF detection algorithm.

Objective 1: Validation of a new state-of-the-art machine learning algorithm against the manufactured-approved AF detection algorithm and three best-in-class algorithms.

Objective 2: Identify subgroups of patients that are at increased risk of adverse outcomes of new onset atrial fibrillation in ICU compared to those who are not.

Inclusion criteria

• Willing and able to give informed consent for participation in the study, or favourable consultee advice for adults lacking capacity
• Male or Female,
• aged 16 years or above.
• Admitted to intensive care for >24 hours
• New onset atrial fibrillation as confirmed by 12 lead ECG-

Exclusion criteria

• History of atrial fibrillation
• Unable to undergo cardiac monitoring
• Previously included in the study
• Not anticipated by treating consultant to survive to ICU discharge (withdrawal or limitation of medical treatment at time of screening)
• Contraindication to anticoagulation
• Unable to wear the device for the prescribed monitoring period
• Implanted neurostimulator, as this may disrupt the ECG recording