Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

Lewis, O. J.; Ngwa, Julius S.; Gillum, Richard F.; Thomas, Alicia; Davis, Wayne; Poddar, Vishal; Adams, George R; Thomas, Alvin; Mehari, Alem

doi:10.18865/ed.26.2.205

Cited by 16 publications

(18 citation statements)

References 39 publications

(63 reference statements)

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“…Thirty-six studies reported on the incidence of AF (Table 2). 16, 17, 22–55 One study was published in Hebrew, while all others were in English. Twenty-three studies evaluated patients in an ICU, and 13 studies evaluated patients in a hospital ward setting.…”

Section: Resultsmentioning

confidence: 99%

Atrial fibrillation detected initially during acute medical illness: A systematic review

McIntyre

Cheung

et al. 2018

European Heart Journal: Acute Cardiovascular Care

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Objective: There is uncertainty about the incidence of and prognosis associated with atrial fibrillation that is documented for the first time in the setting of an acute stressor, such as surgery or medical illness. Our objective was to perform a systematic review of the incidence and long-term recurrence rates for atrial fibrillation occurring transiently with stress in the setting of acute medical illness. Data sources: Medline, Embase and Cochrane Central to September 2017. Study selection: We included retrospective and prospective observational studies, and randomised controlled trials. The population of interest included patients hospitalised for medical (i.e. non-surgical) illness who developed newly diagnosed atrial fibrillation. Studies were included if they included data on either the incidence of atrial fibrillation or the rate of atrial fibrillation recurrence in atrial fibrillation occurring transiently with stress patients following hospital discharge. Data extraction: Two reviewers collected data independently and in duplicate. We characterised each study’s methodology for ascertainment of prior atrial fibrillation history, atrial fibrillation during hospitalisation and atrial fibrillation recurrence after hospital discharge. Data synthesis: Thirty-six studies reported the incidence of atrial fibrillation. Ten used a prospective design and included a period of continuous electrocardiographic (ECG) monitoring. Atrial fibrillation incidence ranged from 1% to 44%, which was too heterogeneous to justify meta-analysis ( I2=99%). In post-hoc meta-regression models, the use of continuous ECG monitoring explained 13% of the variance in atrial fibrillation incidence, while care in an intensive care unit explained none. Two studies reported the long-term rate of atrial fibrillation recurrence following atrial fibrillation occurring transiently with stress. Neither of these studies used prospective, systematic monitoring. Recurrence rates at 5 years ranged from 42% to 68%. Conclusions: The incidence of atrial fibrillation with medical illness may be as high as 44%, with higher estimates in reports using continuous ECG monitoring. Within 5 years following hospital discharge, atrial fibrillation recurrence is documented in approximately half of patients; however, the true rate may be higher. Protocol registration PROSPERO CRD42016043240

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Section: Resultsmentioning

confidence: 99%

Atrial fibrillation detected initially during acute medical illness: A systematic review

McIntyre

Cheung

et al. 2018

European Heart Journal: Acute Cardiovascular Care

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“…46 Regarding other classical risk factors for AF 47 like diabetes, hypertension, obesity, and cardiovascular disease, 11 studies showed that some of those were associated with new-onset AF in sepsis. [23][24][25][26][27]29,[41][42][43][44][45] However in five studies these classical risk factors were not related with new-onset AF, 20,28,29,40,48 thus underlining that new-onset AF in patients with septic syndromes may also be initiated by elevated levels of pro-inflammatory cytokines by activation of the catecholaminergic system, electrolyte alterations, and alteration in volume status during sepsis. 8, 38,39 Regarding echocardiographic findings, Ferrera et al 26 and Liu et al 25 reported that left atrial dimension was larger in patients with new-onset AF than in those who remained in SR. Conversely, in the study of Guenancia et al, 40 there were no differences in left atrial dimension among patients with new-onset AF and those with SR, although new-onset AF patients had a lower left ventricular ejection fraction than patients in SR. 40 Wetterslev et al 49 used three categories to classify the risk factors for development of new-onset AF in adult critically ill patients: (1) predisposing factors, (2) condition-related precipitating factors, and (3) treatment-related precipitating factors.…”

Section: Physiopathology and Risk Factors For New-onset Atrial Fibrilmentioning

confidence: 93%

“…In-hospital mortality in patients with new-onset AF and sepsis was described in 16 studies. In 10 studies, in-hospital mortality was higher in patients with new-onset AF than in patients with SR. 20,[22][23][24][25][26][27][28][29]43 In four studies, 40,44,48,50 the overall ICU-and inhospital mortality rates were similar between patients with and without new-onset AF and two studies were performed in survivors after sepsis. 41,45 Estimated odds ratio (OR) ranged from 1.9 (95% confidence interval [CI], 1.01-4.11) to 5.7 (95% CI, 3.8-8.6) for in-hospital mortality.…”

Section: Morbidity and Mortalitymentioning

confidence: 97%

“…In 14 out of the 17 studies analyzed, older age was reported as an independent risk factor for new-onset AF in septic patients. [22][23][24][25][26][27][28][29][40][41][42][43][44][45] In this sense, it is well known that older age is a risk factor for AF not only in the general population, but also in ICU patients. 46 Regarding other classical risk factors for AF 47 like diabetes, hypertension, obesity, and cardiovascular disease, 11 studies showed that some of those were associated with new-onset AF in sepsis.…”

Section: Physiopathology and Risk Factors For New-onset Atrial Fibrilmentioning

confidence: 99%

“…18 New-onset AF that occurs in the setting of sepsis could be associated with increased length of stay in ICU, 8 long-term stroke risk, and mortality risk. 20,[22][23][24][25][26][27][28][29] The risk of ischemic stroke among patients with new-onset AF during sepsis seems to be higher than in the general population with AF and higher than in patients with sepsis who do not have new-onset AF. 27 However, there is no evidence to support anticoagulant treatment for stroke prevention in patients with new-onset AF during sepsis.…”

mentioning

confidence: 97%

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New-Onset Atrial Fibrillation in Sepsis: A Narrative Review

Aibar

Schulman

2020

Semin Thromb Hemost

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Atrial fibrillation (AF) is a frequently identified arrhythmia during the course of sepsis. The aim of this narrative review is to assess the characteristics of patients with new-onset AF related to sepsis and the risk of stroke and death, to understand if there is a need for anticoagulation. We searched for studies on AF and sepsis on PubMed, the Cochrane database, and Web of Science, and 17 studies were included. The mean incidence of new-onset AF in patients with sepsis was 20.6% (14.7% in retrospective studies and 31.6% in prospective). Risk factors for new-onset AF included advanced age, white race, male sex, obesity, history of cardiopulmonary disease, heart or respiratory failure, and higher disease severity score. In-hospital mortality was higher in patients with than in those without new-onset AF in 10 studies. In four studies the overall intensive care unit and hospital mortality rates were comparable between patients with and without new-onset AF, while three other studies did not provide mortality data. One study reported on the in-hospital incidence of stroke, which was 2.6 versus 0.69% in patients with or without new-onset AF, respectively. Seven of the studies provided follow-up data after discharge. In three studies, new-onset AF was associated with excess mortality at 28 days, 1 year, and 5 years after discharge of 34, 21, and 3% patients, respectively. In two studies, the mortality rate was comparable in patients with and without new-onset AF. Postdischarge stroke was reported in five studies, whereof two studies had no events after 30 and 90 days, one study showed a nonsignificant increase in stroke, and two studies demonstrated a significant increase in risk of stroke after new-onset AF. The absolute risk increase was 0.6 to 1.6%. Large prospective studies are needed to better understand the need for anticoagulation after new-onset AF in sepsis.

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New-onset atrial fibrillation in adult critically ill patients: a scoping review

et al. 2019

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Incidence, Risk Factors and Outcomes of New Onset Supraventricular Arrhythmias in African American Patients with Severe Sepsis

Abstract: hospital mortality. However, after multiple adjustments, new onset SVA did not remain an independent predictor of mortality. Ethn

Cited by 16 publications

References 39 publications

Atrial fibrillation detected initially during acute medical illness: A systematic review

Atrial fibrillation detected initially during acute medical illness: A systematic review

New-Onset Atrial Fibrillation in Sepsis: A Narrative Review

New-onset atrial fibrillation in adult critically ill patients: a scoping review

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