Introduction:

Postoperative atrial fibrillation (POAF) is common after cardiac surgery and associated with increased hospital length of stay, patient morbidity and mortality. We aimed to identify factors associated with POAF and evaluate the accuracy of available POAF prediction models.

Methods:

We screened articles from Ovid MEDLINE^® and PubMed Central^® (PMC) and included studies that evaluated risk factors associated with POAF or studies that designed or validated POAF prediction models. We only included studies in cardiac surgical patients with sample size n ⩾ 50 and a POAF outcome group ⩾20. We summarised factors that were associated with POAF and assessed prediction model performance by reviewing reported calibration and discriminative ability.

Results:

We reviewed 232 studies. Of these, 142 fulfilled the inclusion criteria. Age was frequently found to be associated with POAF, while most other variables showed contradictory findings, or were assessed in few studies. Overall, 15 studies specifically developed and/or validated 12 prediction models. Of these, all showed poor discrimination or absent calibration in predicting POAF in externally validated cohorts.

Conclusions:

Except for age, reporting of factors associated with POAF is inconsistent and often contradictory. Prediction models have low discrimination, missing calibration statistics, are at risk of bias and show limited clinical applicability. This suggests the need for studies that prospectively collect AF relevant data in large cohorts and then proceed to validate findings in external data sets.

中文翻译：

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预测心脏手术后心房颤动：相关因素的范围审查和现有预测模型的系统审查

介绍：

术后心房颤动（POAF）在心脏手术后很常见，并与住院时间、患者发病率和死亡率增加相关。我们的目的是确定与 POAF 相关的因素并评估可用 POAF 预测模型的准确性。

方法：

我们筛选了来自 Ovid MEDLINE ^®和 PubMed Central ^® (PMC) 的文章，并纳入了评估与 POAF 相关风险因素的研究或设计或验证 POAF 预测模型的研究。我们仅纳入了样本量n≥50且 POAF 结果组≥20 的心脏手术患者的研究。我们总结了与 POAF 相关的因素，并通过审查报告的校准和判别能力来评估预测模型的性能。

结果：

我们回顾了 232 项研究。其中，142 人符合纳入标准。年龄经常被发现与 POAF 相关，而大多数其他变量显示出相互矛盾的结果，或者在少数研究中进行了评估。总体而言，15 项研究专门开发和/或验证了 12 种预测模型。其中，在外部验证的队列中预测 POAF 时，所有这些都表现出较差的辨别力或缺乏校准。

结论：

除年龄外，与 POAF 相关的因素的报告不一致且常常相互矛盾。预测模型的辨别力低、缺少校准统计数据、存在偏差风险并且临床适用性有限。这表明需要进行前瞻性研究，在大型队列中收集 AF 相关数据，然后继续验证外部数据集中的研究结果。