Presentation Details
| Pre-operative Glucagon-like Peptide-1 Receptor Agonist (GLP-1RA) Use and the Risk of New Onset Atrial Fibrillation during the Post-operative Period of Noncardiac Surgery in Older Adults Anna Zhang1, Rong Xu2, David Kaelber3, 4, Pauline Terebuh2. 1Case Western Reserve University School of Medicine, Cleveland, OH, USA.2Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.3The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA.4The Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA |
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complication in older adults, associated with increased risk of stroke, prolonged hospitalization, and higher healthcare costs. GLP-1RAs have cardioprotective effects, however, their role in POAF remains unclear. This study evaluates the association between pre-operative GLP-1RA prescriptions and incidence of POAF after noncardiac surgery.
METHODS: We conducted a retrospective cohort study using the U.S. Collaborative Network of the TriNetX aggregated and de-identified electronic health record platform. Patients aged ≥50 years with at least one diabetes type 2 (DM2) International Classification of Diseases-Tenth Revision (ICD-10) encounter diagnosis and no prior documentation of AF were identified. The cohort was divided into patients with prescription for GLP-1RA versus other antidiabetes medication before surgery. All patients subsequently underwent an orthopedic or abdominal surgery (based on CPT codes) between January 2017 and December 2024 and were compared after propensity score matching for demographics and comorbidities. The risk of POAF within 90 days of the surgery was compared using hazard ratios with 95% CIs.
RESULTS: After matching, 16,863 patients remained in each orthopedic cohort. GLP-1RA prescriptions were found to have similar risk of POAF encounter diagnoses compared with control (HR=0.92, 95% CI 0.75-1.22), with 184 AF cases in GLP-1RA group versus 200 in control. In the abdominal surgery cohort of 11,696 patients each (after matching), GLP-1RA prescriptions were associated with a decreased risk of POAF (HR=0.80, 95% CI 0.66-0.97), with 182 AF cases in GLP-1RA group versus 227 in control.
CONCLUSIONS: A significant reduction in POAF risk was associated with pre-operative GLP-1RA prescription for surgeries that carry a moderate risk of POAF (abdominal), but not for lower risk procedures (orthopedic) in older adults. Future research on the optimal timing of GLP-1RA treatment to balance both its benefits and risks during the pre-operative and post-operative period would inform perioperative guidance.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: We conducted a retrospective cohort study using the U.S. Collaborative Network of the TriNetX aggregated and de-identified electronic health record platform. Patients aged ≥50 years with at least one diabetes type 2 (DM2) International Classification of Diseases-Tenth Revision (ICD-10) encounter diagnosis and no prior documentation of AF were identified. The cohort was divided into patients with prescription for GLP-1RA versus other antidiabetes medication before surgery. All patients subsequently underwent an orthopedic or abdominal surgery (based on CPT codes) between January 2017 and December 2024 and were compared after propensity score matching for demographics and comorbidities. The risk of POAF within 90 days of the surgery was compared using hazard ratios with 95% CIs.
RESULTS: After matching, 16,863 patients remained in each orthopedic cohort. GLP-1RA prescriptions were found to have similar risk of POAF encounter diagnoses compared with control (HR=0.92, 95% CI 0.75-1.22), with 184 AF cases in GLP-1RA group versus 200 in control. In the abdominal surgery cohort of 11,696 patients each (after matching), GLP-1RA prescriptions were associated with a decreased risk of POAF (HR=0.80, 95% CI 0.66-0.97), with 182 AF cases in GLP-1RA group versus 227 in control.
CONCLUSIONS: A significant reduction in POAF risk was associated with pre-operative GLP-1RA prescription for surgeries that carry a moderate risk of POAF (abdominal), but not for lower risk procedures (orthopedic) in older adults. Future research on the optimal timing of GLP-1RA treatment to balance both its benefits and risks during the pre-operative and post-operative period would inform perioperative guidance.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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