AHA
Scientific Sessions 2011
ORLANDO, Fla. — Patients with severe sepsis and new-onset atrial fibrillation are at
increased risk for in-hospital stroke and death compared with patients with
severe sepsis and pre-existing or no atrial fibrillation, researchers reported
in a new study published in the Journal of the American Medical
Association.
Using 2007 discharge data from the California State In-patient Database,
researchers examined hospitalizations for more than 3 million patients with
severe sepsis (mean age, 69 years) to determine whether in-hospital stroke and
mortality risks were associated with AF.
Overall, 49,082 patients in the database were identified as having
severe sepsis. New-onset AF, defined as AF that occurred during a hospital
stay, occurred in 5.9% of patients with severe sepsis vs. 0.65% without severe
sepsis (OR=6.82; 95% CI, 6.54-7.11). Similarly, severe sepsis was present in
14% of all new-onset AF in hospitalized adults, according to the study
abstract.
Patients with new-onset AF during severe sepsis has a 2.6% increased
risk for in-hospital stroke compared with 0.6% of patients with severe sepsis
but no AF (OR=2.70; 95% CI, 2.05-3.57). Risk for in-hospital mortality was also
greater with new-onset AF during severe sepsis (56% vs. 39%; RR=1.07; 95% CI,
1.04-1.11).
“The increased stroke and mortality risks observed with new-onset
AF were robust across two definitions of severe sepsis, multiple methods of
addressing confounding and multiple sensitivity analyses,” the researchers
wrote.
Factors associated with increased risk for new-onset AF during severe
sepsis included increasing age; male sex; white race; and history of HF,
obesity, malignancy and stroke, among others.
“Given projected estimates of severe sepsis in 1 million Americans
in 2011, it is likely that new-onset AF occurs in more than 60,000 patients
with severe sepsis in the United States each year,” the researchers wrote.
“Current guidelines do not address AF that occurs in the setting of severe
sepsis or acute infection, suggesting that new-onset AF that occurs during
severe sepsis is an underrecognized public health problem.”
For more information:
Disclosure: The researchers report no relevant financial
disclosures.