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Stroke, death risk higher in patients with new-onset AF hospitalized for severe sepsis

Issue: April 2012

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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:

• Walkey AJ. JAMA. 2011;doi:10.1001/jama.2011.1615.
• Walkey AJ. Abstract #8688. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.

Disclosure: The researchers report no relevant financial disclosures.

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