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Sepsis Patients With New-Onset Atrial Fibrillation at Risk of In-Hospital Stroke, Death

Patients who are hospitalized with severe sepsis and then experience atrial fibrillation have an increased risk of in-hospital stroke and death, according to a new study.

Atrial fibrillation (AF)- an irregular or rapid heart beat - is one of the most common arrhythmias among patients who are critically ill.

Previous studies have shown that 6 to 20 percent of patients with severe sepsis develop new-onset AF, which suggests severe sepsis may be a predisposing factor for new-onset AF, the study‘s authors say.

While chronic AF is a known risk factor for stroke and death, the clinical significance of new-onset AF related to severe sepsis is not certain.

Dr. Alan J. Walkey, and colleagues at Boston University School of Medicine conducted a study that included data from the California State Inpatient Database from nonfederal acute care hospitals for the 12 months of 2007.

Researchers identified 49,082 cases of severe sepsis that met qualifying criteria for the study. New-onset AF was defined as AF occurring during the hospital stay that excluded AF cases present at admission.

New-onset AF occurred during 20,608 hospitalizations, which included sepsis and nonsepsis patients, and during 2,896 hospitalizations of patients with severe sepsis. Analysis showed 14 percent of all hospital-associated new-onset AF occurred within the context of severe sepsis.

Patients with severe sepsis had almost 7 times the odds of having new-onset AF, compared to hospitalized patients without severe sepsis. Associated factors include demographics (male sex, increasing age, white race), other illnesses (history of heart failure, malignancy, obesity, and stroke), and acute factors (respiratory, organ and renal failure.

Among those with severe sepsis, new-onset AF was associated with increased adjusted risks of in-hospital ischemic stroke, which was not the case for severe sepsis patients that had preexisting AF. In patients with severe sepsis, in-hospital ischemic stroke occurred in 75 of 2,896 individuals with new-onset AF compared with 57 of 9,986 with preexisting AF and 249 of 36,200 without AF.

Compared with severe sepsis patients without new-onset AF, patients with new-onset AF had a greater risk of in-hospital mortality with 1,629 deaths or 56 percent compared to 18,027 deaths or 39 percent.

Given the projected 2011 estimate of 1 million Americans with severe sepsis, researchers say it is likely that new-onset AF occurs in more than 60,000 of those patients each year, suggesting that it is an under recognized public health problem.

If the findings of this study are replicated in future studies, researchers suggest it will be important to focus on strategies that might decrease the risk of adverse outcomes linked to AF during severe sepsis.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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