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Trends and Outcomes in Sepsis Hospitalizations With and Without Atrial Fibrillation: A Nationwide Inpatient Analysis

Desai, Rupak MBBS1; Hanna, Bishoy MD2; Singh, Sandeep MBBS3; Omar, Ahmed MD4; Deshmukh, Abhishek MD5; Kumar, Gautam MD1,6; Foreman, Marilyn G. MD7; Sachdeva, Rajesh MD1,2,6

doi: 10.1097/CCM.0000000000003806
Online Clinical Investigations

Objectives: Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fibrillation and its impact on outcomes of sepsis-related hospitalizations.

Design: Retrospective cohort study.

Setting: The National Inpatient Sample databases (2010–2014).

Patients: Primary discharge diagnosis of sepsis with and without atrial fibrillation were identified using prior validated International Classification of Diseases, 9th Edition, Clinical Modification codes.

Interventions: None.

Measurements and Main Results: Overall, 5,808,166 hospitalizations with the primary diagnosis of sepsis, of which 19.4% (1,126,433) were associated with atrial fibrillation. The sepsis-atrial fibrillation cohort consisted of older (median [interquartile range] age of 79 yr [70–86 yr] vs 67 yr [53–79 yr]; p < 0.001) white (80.9% vs 68.8%; p < 0.001) male (51.1% vs 47.5%; p < 0.001) patients with an extended length of stay (median [interquartile range] 6 d [4–11 d] vs 5 d [3–9 d]; p < 0.001) and higher hospitalization charges (median [interquartile range] $44,765 [$23,234–$88,657] vs $35,737 [$18,767–$72,220]; p < 0.001) as compared with the nonatrial fibrillation cohort. The all-cause mortality rate in the sepsis-atrial fibrillation cohort was significantly higher (18.4% and 11.9%; p = 0.001) as compared with those without atrial fibrillation. Although all-cause mortality (20.4% vs 16.6%) and length of stay (median [interquartile range] 7 d [4–11 d] vs 6 d [4–10 d]) decreased between 2010 and 2014, hospitalization charges increased (median [interquartile range] $41,783 [$21,430–$84,465] vs $46,251 [$24,157–$89,995]) in the sepsis-atrial fibrillation cohort. The greatest predictors of mortality in the atrial fibrillation-sepsis cohort were African American race, female gender, advanced age, and the presence of medical comorbidities.

Conclusions: The presence of atrial fibrillation among sepsis-related hospitalizations is a marker of poor prognosis and increased mortality. Although we observed rising trends in sepsis and sepsis-atrial fibrillation–related hospitalizations during the study period, the rate and odds of mortality progressively decreased.

1Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA.

2Division of Cardiology, Morehouse School of Medicine, Atlanta, GA.

3Division of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.

4Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA.

5Division of Cardiology, Mayo Clinic, Rochester, MN.

6Division of Cardiology, Emory University School of Medicine, Atlanta, GA.

7Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA.

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The authors have disclosed that they do not have any potential conflicts of interest.

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