Association Between Protocolized Magnesium Supplementation and Atrial Fibrillation or Flutter in Critically Ill Patients: A Multicenter Retrospective Cohort Study
Yarnell CJ, Angriman F, Beaubien E, Brown J, Bruce-Kemevor S, Burry L, Craig J, Donato-Woodger S, Fernando SM, Fowler R, Kattakkayam T, Lamontagne F, Prakash V, Sikaneta T, Sibley S, Soliman K, Tomlinson G, Bodley T
Critical care medicine · 1 citation
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2026-01-30 · Crit Care Med · vol. 54 · issue 5 · pp. 1136–1146
- Publisher
- Lippincott Williams & Wilkins
- Cited
- 5 citations · more than 99% of similar papers · 21.6× the field average
- Impact
- Top 10% most cited in its field
- References
- 27 works
- Access
- Paywalled
- Research areas
- Magnesium in Health and Disease · Parathyroid Disorders and Treatments · Magnesium Alloys: Properties and Applications
- Keywords
- Critically ill, Atrial fibrillation, Atrial flutter, Retrospective cohort study, Incidence (geometry), Flutter, Cohort study, Cohort
- MeSH
- humans, atrial fibrillation, atrial flutter, critical illness, magnesium, clinical protocols, retrospective studies, dietary supplements, aged, middle aged, intensive care units, ontario, female, male
18 authors
From CA, GB
- Christopher J. YarnellUniversity Health Network; University of Toronto; Scarborough Health Network
- Federico AngrimanSunnybrook Health Science Centre; University of Toronto; Health Sciences Centre
- Eliot R. BeaubienUniversity of Calgary; Peterborough Regional College
- J. Howard BrownPeterborough Regional College; Trent University
- Selasi Bruce-KemevorScarborough Health Network
- Lisa BurryUniversity of Toronto
Abstract
Objectives
Most ICUs use protocolized magnesium supplementation, yet the clinical effect of this practice is unknown.
Design
Pseudo-randomized retrospective study comparing patients who were and were not assigned to receive magnesium supplementation, using a protocol where supplementation occurs when serum levels are less than or equal to 0.95 mmol/L (2.31 mg/dL). Primary outcome was atrial fibrillation or flutter within 24 hours. Secondary outcomes were tachyarrhythmia (supraventricular tachycardia or ventricular arrhythmia) and death within 24 hours.
Setting
ICUs with a shared magnesium supplementation protocol, in five hospitals in Ontario, Canada, from January 1, 2022, to December 31, 2024.
Patients
Adults (18 yr old or older) admitted to ICU with a magnesium protocol order, at their first magnesium level of 0.92-0.99 mmol/L (2.24-2.41 mg/dL). To minimize confounding, we included only patients with a level near the supplementation threshold.
Interventions
None.
Exposure
Magnesium level 0.92-0.95 mmol/L (2.24-2.31 mg/dL, supplementation group) vs. 0.96-0.99 mmol/L (2.32-2.41 mg/dL, no supplementation group).
Measurements and main results
We identified 4198 patients; median age 70 years, 41% female, 39% invasively ventilated; 2144 (51%) in the supplementation group, of whom 77% received magnesium, and 2054 (49%) in the no supplementation group, of whom 9% received magnesium. Atrial fibrillation or flutter occurred within 24 hours in 355 (16.6%) in the supplementation group and 375 (18.3%) in the no supplementation group. Bayesian logistic regression, adjusted for hospital, showed a 1.6% absolute risk reduction associated with supplementation (95% credible interval, 3.8% reduction to 0.8% increase; probability of reduction, 0.91). For the composite outcome of atrial fibrillation and flutter, tachyarrhythmia, and death, the absolute risk reduction associated with supplementation was 2.2% (CrI, 4.3% reduction to 0.1% increase; probability of risk reduction, 0.97).
Conclusions
Protocolized magnesium supplementation at a threshold of 0.95 mmol/L (2.31 mg/dL) may be associated with reduced 24-hour incidence of atrial fibrillation and flutter in critically ill patients.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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