A new computational risk assessment prediction tool developed by anesthesiologists at Montefiore Health System and Albert Einstein College of Medicine helps to predict who would benefit from anti-blood clot medications after non-cardiac surgery. The advance, published in Nature Medicine, could reduce the risk of atrial fibrillation (AF) and stroke.

Matthias Eikermann, MD, PhD

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Approximately 50 million patients in the United States undergo non-cardiac surgical procedures annually, and it is estimated that up to one quarter of these individuals may experience new-onset post-operative atrial fibrillation (POAF), an irregular heart rhythm that can cause blood clots in the heart, increasing the risk of stroke, heart failure and other heart-related complications.

Montefiore researchers assessed the association of POAF and stroke in more than 250,000 patients who underwent non-cardiac surgery at Montefiore Health System in New York and Beth Israel Deaconess Hospital in Boston. While none of the patients had previously been diagnosed with atrial fibrillation, the researchers found that almost 5,000 patients had AF detected after surgery, and for those who received anticoagulation medications, their risk of stroke within one year after surgery reduced by half.

Existing guidelines do not provide strong recommendations on the prevention, detection and treatment of POAF. AF increases the risk of stroke by up to five-fold so improved diagnosis and treatment of POAF could substantially reduce incidences of stroke. Montefiore’s new computational tool determines a patient’s risk of developing POAF, based on nine factors, including age, sex and other existing health conditions.

“These findings have the potential to be practice-changing,” said principal investigator Matthias Eikermann, M.D., the Francis F. Foldes Professor and Chair, Department of Anesthesiology at Montefiore Health System and Albert Einstein College of Medicine. “Right now, it is estimated that only one in three patients with POAF receive appropriate medications to prevent risk of AF and stroke. With the use of our computational risk assessment prediction tool and subsequent monitoring and treatment of high-risk patients, it is possible that far fewer people will experience adverse outcomes after non-cardiac surgery.”