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Critical care Atrial Fibrillation Evaluation (CAFE) study will bring together the best evidence on which to base improved guidelines for treatment of patients who develop atrial fibrillation on an ICU.

The University of Oxford Critical Care Research Group is working in collaboration with ICNARC to investigate why some people develop atrial fibrillation during their stay in intensive care. The project is also looking at how best to treat this.

Atrial fibrillation is a heart problem causing a fast, irregular heartbeat. This reduces the heart’s ability to pump blood around the body. It also causes blood clots to form inside the heart. These can spread through the blood vessels to other parts of the body. These clots can cause strokes if they spread to the brain.

Atrial fibrillation is a common problem in patients outside intensive care units (ICUs) and good, evidence-based, guidelines exist to help doctors treat people who develop this condition. Around 10% of people treated on an ICU develop atrial fibrillation as a complication of their severe underlying illness. This additional problem makes them more unstable, so they stay longer in the ICU and have worse outcomes. Atrial fibrillation therefore needs prompt and effective treatment to prevent further harm.

Treatments for atrial fibrillation that work in people outside the ICU may not work in people treated on an ICU who are already very ill before their heart changes rhythm. This means that guidelines for treating atrial fibrillation outside ICU are not helpful for patients treated on an ICU. There is uncertainty about what is the best treatment and practices differ between countries, and between different ICUs in the same country.

People who have atrial fibrillation outside ICU often have their blood thinned to reduce their risk of stroke. However, this treatment can cause bleeding. Risk scoring systems are used to help doctors balance the risk of bleeding against the risk of stroke, but these scoring systems may not work for patients admitted to ICUs. This is because the risk of bleeding is higher, and the risk of stroke is not well understood.

Critical care Atrial Fibrillation Evaluation (CAFE) study will bring together the best evidence on which to base improved guidelines for treatment of patients who develop atrial fibrillation on an ICU.

For more information about the CAFE study, please visit the ICNARC website.