Background: Sepsis is associated with a six-fold greater risk of developing new-onset atrial fibrillation (AF). Patients with new onset AF demonstrate increased risk of stroke, vascular events, and death. However, the characteristics and management of new onset AF have not been well-described.
Methods: We conducted a retrospective cohort study of patients aged ≥ 18 years who were hospitalized with a principal or secondary diagnosis of sepsis and concomitant diagnosis of new-onset AF or atrial flutter from 2012-2017. Medical record review identified patient characteristics (including demographics, co-morbid conditions, and CHA2DS2¬-VASc score); inpatient care received (including critical care therapies, ventilation strategies, and treatment upon discharge); and outcomes (recurrent AF, in-hospital outcomes, and longer term outcomes).
Results: Of the 202 eligible patients, 56.9% were men, and mean age was 71.4 years. Most (113, 55.9%) were admitted to an inpatient critical care unit, 75 (37.1%) received invasive mechanical ventilation, and 73 (36.1%) received vasopressors. Contrary to prior reports, most (159/202, 78.7%) had at least one cardiovascular co-morbidity and most (135/202, 66.8%) had a CHA2DS2-VASc score ≥ 3. Approximately one-third of patients received anticoagulation (74/202, 36.6%) during hospitalization, while another one-third of patients (74/202, 36.6%) received anticoagulation on discharge. Most patients were managed with rate control therapy (165/202, 81.7%). There were 16 deaths documented in the medical record, within one year following discharge (16/202, 7.9%). Among the surviving 46 patients, (14/46, 30.4%) had documented recurrence of AF and 8 (17.4%) had nonfatal myocardial infarctions or embolic events within one year post-discharge.
Conclusions: Patients who developed new onset AF in the setting of sepsis carried a high risk for stroke at the time of admission. Moreover, within one year following discharge, many patients developed recurrent AF or non-fatal vascular events, confirming prior reports of poor outcomes in patients with sepsis and AF.