Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis.
OBJECTIVE
New onset supraventricular arrhythmias (SVA) are commonly reported in mixed intensive care settings. We sought to determine the incidence, risk factors and outcomes of new onset SVA in African American (AA) patients with severe sepsis admitted to medical intensive care unit (MICU).


METHODS
Patients admitted to MICU between January 2012 through December 2012 were studied. Patients with a previous history of arrhythmia or with new onset of ventricular arrhythmia were excluded. Data on risk factors, critical care interventions and outcomes were obtained.


RESULTS
One hundred and thirty-one patients were identified. New onset SVA occurred in 34 (26%) patients. Of those 34, 20 (59%) had atrial fibrillation (AF), 6 (18%) had atrial flutter and 8 (24%) had other forms of SVA. Compared with patients without SVA, patients with new onset SVA were older (69 ± 12 yrs vs 59 ± 13 yrs, P=.003), had congestive heart failure (47% vs 24%, P=.015) and dyslipidemia (41% vs 15%, P=.002). Additionally, they had a higher mean mortality prediction model (MPM II) score (65 ± 25 vs 49 ± 26, P=.001) and an increased incidence of respiratory failure (85% vs 55%, P=.001). Hospital mortality in patients with new onset SVA was 18 (53%) vs 30 (31%); P=.024; however, in a multivariate analysis, new onset SVA was associated with non-significantly increased odds (OR 2.58, 95% CI 0.86-8.05) for in-hospital mortality.


CONCLUSIONS
New onset SVA was prevalent in AA patients with severe sepsis and occurred more frequently with advanced age, increased severity of illness, congestive heart failure, and acute respiratory failure; it was associated with higher unadjusted in hospital mortality. However, after multiple adjustments, new onset SVA did not remain an independent predictor of mortality.
Department of Internal Medicine, Howard University College of Medicine; Division of Pulmonary and Critical Care Medicine at Howard University Hospital.
O'Dene
O
Lewis
Department of Internal Medicine, Howard University College of Medicine.
Julius
J
Ngwa
Department of Internal Medicine, Howard University College of Medicine.
Richard F
RF
Gillum
Department of Internal Medicine, Howard University College of Medicine; Division of Pulmonary and Critical Care Medicine at Howard University Hospital.
Alicia
A
Thomas
Department of Internal Medicine, Howard University College of Medicine; Division of Pulmonary and Critical Care Medicine at Howard University Hospital.
Wayne
W
Davis
Department of Internal Medicine, Howard University College of Medicine; Division of Pulmonary and Critical Care Medicine at Howard University Hospital.
Vishal
V
Poddar
Department of Internal Medicine, Howard University College of Medicine; Division of Pulmonary and Critical Care Medicine at Howard University Hospital.
George R
GR
Adams
Department of Internal Medicine, Howard University College of Medicine; Division of Pulmonary and Critical Care Medicine at Howard University Hospital.
Alvin Jr
AJ
Thomas
Department of Internal Medicine, Howard University College of Medicine; Division of Pulmonary and Critical Care Medicine at Howard University Hospital.
Alem
A
Mehari
D001741:Black or African American; D000368:Aged; D001281:Atrial Fibrillation / Q000208:ethnology* / Q000209:etiology; D001282:Atrial Flutter; D005260:Female; D006333:Heart Failure / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D018805:Sepsis / Q000150:complications*
Atrial Fibrillation; Critical Care; Length of Stay; Mortality; Severe Sepsis; Supraventricular Arrhythmia