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.
From the Pulmonary Center and the Section of Pulmonary and Critical Care Medicine, Boston University School of Public Health, Boston, MA. Electronic address: alwalkey@bu.edu.
Allan J
AJ
Walkey
Sections of Cardiovascular Medicine and Preventive Medicine, Department of Medicine, and the Department of Epidemiology, Boston University School of Public Health, Boston, MA.
Bradley G
BG
Hammill
Sections of Cardiovascular Medicine and Preventive Medicine, Department of Medicine, and the Department of Epidemiology, Boston University School of Public Health, Boston, MA.
Lesley H
LH
Curtis
Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, NC.
Emelia J
EJ
Benjamin
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology