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22-11-2011 | Cardiology | Article

New-onset AF poses stroke, death risk in severe sepsis patients

Abstract

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MedWire News: Patients with severe sepsis are at higher risk for in-hospital stroke and death if they develop new-onset atrial fibrillation (AF) than if they have pre-existing or no arrhythmia, US researchers report.

Current guidelines do not make specific recommendations about managing new-onset AF in patients with severe sepsis, remark Allan Walkey (Boston University School of Medicine, Massachusetts) and colleagues.

This, they say, suggests that new-onset AF in the setting of severe sepsis is an underestimated health problem that should be addressed via the implementation of specific management strategies.

The researchers analyzed data obtained from 49,082 patients with a mean age of 69 years. All were hospitalized with severe sepsis.

Of these patients, 36,200 had no AF during hospital stay, 9986 had pre-existing AF on admission, and 2896 developed new onset AF after hospital admission.

When the AF rates in this group were compared with those among a group of age- and gender-matched sepsis-free hospitalized patients, Walkey and team observed a higher rate of new-onset AF among patients with sepsis than in those without, at respective rates of 5.9% and 0.7%.

Among the sepsis group, 381 patients experienced ischemic stroke during hospitalization.

The rate of ischemic stroke was higher among patients with new-onset AF (2.6%) than among those with pre-existing (0.6%) or no AF (0.7%).

This, say the researchers, corresponds to a 2.70-fold higher risk for in-hospital ischemic stroke with new-onset AF compared with pre-existing or no AF, after adjustment for multiple variables, including age, gender, and cause of sepsis.

In-hospital mortality was also 1.07-fold more frequent among patients with new-onset AF compared with any other type of patient, occurring at rates of 56.3%, 43.8%, and 37.7% among patients with new-onset, pre-existing, and no AF, respectively.

"Several potential mechanisms might explain the increased ischemic stroke risk in patients with severe sepsis and new-onset AF," say Walkey and team in JAMA.

They suggest that new-onset AF may be a marker of increased stroke risk, rather than a cause.

"Alternatively, new-onset AF may be a potential source of cardioembolic stroke," they add.

The researchers conclude that further study into the underlying mechanism for new-onset AF in severe sepsis is required.

By Lauretta Ihonor

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