Chest
Volume 146, Issue 5, November 2014, Pages 1187-1195
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Original Research Critical Care
Long-term Outcomes Following Development of New-Onset Atrial Fibrillation During Sepsis

https://doi.org/10.1378/chest.14-0003Get rights and content

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.

Section snippets

Materials and Methods

We used claims data from a nationally representative 5% sample of Medicare beneficiaries. Using the inpatient, outpatient, and professional services' analytic files and the corresponding denominator files from the Centers for Medicare and Medicaid Services, we identified a cohort discharged alive from a hospitalization with sepsis between January 1, 1999, and December 31, 2010. We used previously published and validated methods to identify sepsis hospitalization (International Classification of

Results

We identified 138,722 survivors of a sepsis hospitalization between 1999 and 2010 from a Medicare 5% sample. Medicare beneficiaries who survived sepsis were, on average, 80 years old, 42.5% were men, and 83.6% were white.Table 1 demonstrates the characteristics of patients with sepsis stratified by AF status.

Table 2 demonstrates the occurrence of AF after the index sepsis hospitalization stratified by AF status during the sepsis hospitalization. Death presented a strong competing risk: 44.0% of

Discussion

Among a cohort of Medicare beneficiaries who survived a sepsis hospitalization, we observed that new-onset AF during the sepsis hospitalization was associated with a high risk of AF occurrence within 5 years of the sepsis hospitalization. Our findings challenge the current opinion that new-onset AF during sepsis is generally a transient problem that reverses with resolution of sepsis. In addition, new-onset AF during sepsis was associated with increased risks of postdischarge death, heart

Conclusions

In conclusion, patients with new-onset AF during sepsis have greater risks of future occurrence of AF, heart failure, and death than do sepsis survivors without prior known AF. Future studies are needed to determine if patients with new-onset AF during sepsis would benefit from increased postdischarge surveillance for AF or anticoagulation.

Acknowledgments

Author contributions:A. J. W. is the guarantor of the paper and takes responsibility for the integrity of the work as a whole, from inception to published article. A. J. W., L. H. C., and E. J. B. contributed to the concept and design of the study, interpretation of the results, writing of the manuscript, and approval of the final manuscript; and B. G. H. contributed to the concept and design of the study, interpretation of the results, statistical analyses, design of the figures, writing of

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    FUNDING/SUPPORT:This study was funded by the US National Institutes of Health, National Heart, Lung, and Blood Institute [K01 HL116768 (to Dr Walker) and R01 HL102214, R01 HL092577, R01NS17950 (to Dr Benjamin)].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    originally published Online First April 10, 2014.

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