Atrial fibrillation among Medicare beneficiaries hospitalized with sepsis: Incidence and risk factors

Pulmonary Center and the Section of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA. Electronic address: .
American heart journal (Impact Factor: 4.46). 06/2013; 165(6):949-955.e3. DOI: 10.1016/j.ahj.2013.03.020
Source: PubMed

ABSTRACT Background:
Newly diagnosed atrial fibrillation (AF) during severe sepsis is associated with increased risks of in-hospital stroke and mortality. However, the prevalence, incidence, and risk factors associated with AF during the sepsis syndromes are unclear.

We identified patients with preexisting, newly diagnosed, or no AF in a nationally representative 5% sample of Medicare beneficiaries hospitalized with sepsis between 2004 and 2007. We identified multivariable-adjusted demographic and clinical characteristics associated with development of newly diagnosed AF during a sepsis hospitalization.

A total of 60,209 beneficiaries had a sepsis hospitalization. Mean age was 80.2 years, 44.4% were men, and 83.1% were white. Atrial fibrillation occurred during 25.5% (95% CI 25.2-25.9) of sepsis hospitalizations, including 18.3% (18.0%-18.7%) with preexisting AF and 7.2% (7.0%-7.4%) with newly diagnosed AF. Patients with sepsis requiring intensive care had a greater risk of newly diagnosed AF (10.7%, 95% CI 10.3%-11.1%) compared with patients who did not require intensive care (4.4%, 4.2%-4.5%, P < .001). In multivariable analysis, factors associated with newly diagnosed AF during sepsis included older age, white race, acute organ dysfunction, intensive care unit admission, mechanical ventilation, right heart catheterization, diagnosis of endocarditis, and coronary artery bypass graft surgery. Cardiovascular comorbid conditions generally were not associated with increased risk for newly diagnosed AF during sepsis.

Atrial fibrillation is common among critically ill patients with sepsis. Acute factors, rather than preexisting cardiovascular comorbid conditions, are associated with increased risk for newly diagnosed AF during sepsis, suggesting that mechanisms of newly diagnosed AF during sepsis may differ from the general population of patients with AF.

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    • "Our results also suggested that pre-existing cardiovascular diseases was a risk factor for mortality in patients with severe sepsis. It was reported that new-onset atrial fibrillation was an independent risk factor of stroke and death in patients with severe sepsis [36], [37]. Pre-existing cardiovascular diseases might induce the myocardial remodeling and predispose the patients to the development of new-onset atrial fibrillation. "
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