Key result
Underlying chronic atrial fibrillation in patients with septic shock was associated with slightly higher in-hospital mortality compared to those without it (34.4% vs 34.1%, p=0.049).
Why the study?
While new-onset AF worsens outcomes in septic shock, there is a paucity of research on outcomes in patients with underlying chronic AF who develop septic shock.
Does underlying chronic atrial fibrillation worsen in-hospital mortality and clinical outcomes in patients admitted with septic shock?
Observational (n=353,422)
Yes
Does underlying chronic atrial fibrillation worsen in-hospital mortality and clinical outcomes in patients admitted with septic shock?
Absolute Event Rate: 34.4% vs 34.1%
p-value: p=0.049
Underlying chronic atrial fibrillation is associated with slightly higher in-hospital mortality, increased risk of ischemic stroke, and longer length of stay in patients admitted with septic shock.
New-onset AF in septic shock signals higher mortality; supports vigilant monitoring but leaves causal effects and interventions open for prospective trials.
INTRODUCTION: Atrial fibrillation (AF) is one of the most common arrhythmias among hospitalized patients. Among patients admitted with septic shock (SS), the new occurrence of atrial fibrillation has been associated with an increase in intensive care unit (ICU) length of stay and in-hospital mortality. This is partially related to further reduction in cardiac output and thus worsening organ perfusion due to atrial fibrillation. However, there is a paucity of research on the outcomes of patients who have underlying chronic AF (UCAF) and then develop SS. This study aimed to identify the clinical characteristics and outcomes of patients with UCAF admitted with SS compared to patients with SS without UCAF. METHODS: This study was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with SS, and these patients were stratified into those with and without UCAF. Propensity matching analyses were performed to compare clinical outcomes and in-hospital mortality between the two groups. RESULTS: A total of 353,422 patients with hospitalization for SS were identified, 5.8% (n = 20,772) of whom had UCAF. After 2:1 propensity matching, 20,719 patients were identified as having SS with UCAF, and 41,438 patients were identified as having SS without UCAF. Patients with SS and UCAF had a higher incidence of ischemic stroke [2.5% versus 2.2%, p = 0.012], length of stay [11.5 days versus 10.9 days, p < 0.001], mean total charges [$154,094 versus $144,037, p < 0.001] compared to those with SS without UCAF. In-hospital mortality was high in both groups, but was slightly higher among those with SS and UCAF than those with SS and no UCAF [34.4% versus 34.1%, p = 0.049]. CONCLUSIONS: This study identified UCAF as an adverse prognosticator for clinical outcomes. Patients with SS and UCAF need to be identified as a higher risk category of SS who will require more intensive management.
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Vindhyal et al. (2022) conducted an observational in Septic shock (n=353,422). Underlying chronic atrial fibrillation vs. Septic shock without underlying chronic atrial fibrillation was evaluated on In-hospital mortality (p=0.049). Underlying chronic atrial fibrillation in patients with septic shock was associated with slightly higher in-hospital mortality compared to those without it (34.4% vs 34.1%, p=0.049).
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