Long-term Outcomes Following Development of New-Onset Atrial Fibrillation During Sepsis

      BACKGROUND

      New-onset atrial fibrillation (AF) is associated with adverse outcomes during a sepsis hospitalization; however, long-term outcomes following hospitalization with sepsis-associated new-onset AF are unclear.

      METHODS

      We used a Medicare 5% sample to identify patients who survived hospitalization with sepsis between 1999 and 2010. AF status was defined as no AF, prior AF, or new-onset AF based on AF claims during and prior to a sepsis hospitalization. We used competing risk models to determine 5-year risks of AF occurrence, heart failure, ischemic stroke, and mortality after the sepsis hospitalization, according to AF status during the sepsis admission.

      RESULTS

      We identified 138,722 sepsis survivors, of whom 95,536 (69%) had no AF during sepsis, 33,646 (24%) had prior AF, and 9,540 (7%) had new-onset AF during sepsis. AF occurrence following sepsis hospitalization was more common among patients with new-onset AF during sepsis (54.9%) than in patients with no AF during sepsis (15.5%). Compared with patients with no AF during sepsis, those with new-onset AF during sepsis had greater 5-year risks of hospitalization for heart failure (11.2% vs 8.2%; multivariable-adjusted hazard ratio [HR], 1.25; 95% CI, 1.16-1.34), ischemic stroke (5.3% vs 4.7%; HR, 1.22; 95% CI, 1.10-1.36), and death (74.8% vs 72.1%; HR, 1.04; 95% CI,1.01-1.07).

      CONCLUSIONS

      Most sepsis survivors with new-onset AF during sepsis have AF occur after discharge from the sepsis hospitalization and have increased long-term risks of heart failure, ischemic stroke, and death. Our findings may have implications for posthospitalization surveillance of patients with new-onset AF during a sepsis hospitalization.
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      Linked Article

      • Atrial Fibrillation During Sepsis
        CHESTVol. 146Issue 5
        • In Brief
          Despite the advancement of antimicrobial agents, sepsis remains a major global health issue and leading cause of death in low-income countries. In the United States, severe sepsis affects up to 750,000 Americans and is associated with a high mortality rate.1 In severe sepsis, atrial fibrillation (AF) also commonly occurs.2 Sepsis may precipitate AF per se, perhaps unmasking a propensity to develop the arrhythmia, or the association could reflect greater clinical vigilance or monitoring during treatment (or hospitalization) for severe sepsis.
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