Chest
Original Research Critical CareLong-term Outcomes Following Development of New-Onset Atrial Fibrillation During Sepsis
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)].
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originally published Online First April 10, 2014.