Skip to main content
Journal cover image

Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.

Publication ,  Journal Article
Walkey, AJ; Wiener, RS; Ghobrial, JM; Curtis, LH; Benjamin, EJ
Published in: JAMA
November 23, 2011

CONTEXT: New-onset atrial fibrillation (AF) has been reported in 6% to 20% of patients with severe sepsis. Chronic AF is a known risk factor for stroke and death, but the clinical significance of new-onset AF in the setting of severe sepsis is uncertain. OBJECTIVE: To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis. DESIGN AND SETTING: Retrospective population-based cohort of California State Inpatient Database administrative claims data from nonfederal acute care hospitals for January 1 through December 31, 2007. PATIENTS: Data were available for 3,144,787 hospitalized adults. Severe sepsis (n = 49,082 [1.56%]) was defined by validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 995.92. New-onset AF was defined as AF that occurred during the hospital stay, after excluding AF cases present at admission. MAIN OUTCOME MEASURES: A priori outcome measures were in-hospital ischemic stroke (ICD-9-CM codes 433, 434, or 436) and mortality. RESULTS: Patients with severe sepsis were a mean age of 69 (SD, 16) years and 48% were women. New-onset AF occurred in 5.9% of patients with severe sepsis vs 0.65% of patients without severe sepsis (multivariable-adjusted odds ratio [OR], 6.82; 95% CI, 6.54-7.11; P < .001). Severe sepsis was present in 14% of all new-onset AF in hospitalized adults. Compared with severe sepsis patients without new-onset AF, patients with new-onset AF during severe sepsis had greater risks of in-hospital stroke (75/2896 [2.6%] vs 306/46,186 [0.6%] strokes; adjusted OR, 2.70; 95% CI, 2.05-3.57; P < .001) and in-hospital mortality (1629 [56%] vs 18,027 [39%] deaths; adjusted relative risk, 1.07; 95% CI, 1.04-1.11; P < .001). Findings were robust across 2 definitions of severe sepsis, multiple methods of addressing confounding, and multiple sensitivity analyses. CONCLUSION: Among patients with severe sepsis, patients with new-onset AF were at increased risk of in-hospital stroke and death compared with patients with no AF and patients with preexisting AF.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

November 23, 2011

Volume

306

Issue

20

Start / End Page

2248 / 2254

Location

United States

Related Subject Headings

  • Stroke
  • Severity of Illness Index
  • Sepsis
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Hospital Mortality
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Walkey, A. J., Wiener, R. S., Ghobrial, J. M., Curtis, L. H., & Benjamin, E. J. (2011). Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA, 306(20), 2248–2254. https://doi.org/10.1001/jama.2011.1615
Walkey, Allan J., Renda Soylemez Wiener, Joanna M. Ghobrial, Lesley H. Curtis, and Emelia J. Benjamin. “Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.JAMA 306, no. 20 (November 23, 2011): 2248–54. https://doi.org/10.1001/jama.2011.1615.
Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011 Nov 23;306(20):2248–54.
Walkey, Allan J., et al. “Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.JAMA, vol. 306, no. 20, Nov. 2011, pp. 2248–54. Pubmed, doi:10.1001/jama.2011.1615.
Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011 Nov 23;306(20):2248–2254.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

November 23, 2011

Volume

306

Issue

20

Start / End Page

2248 / 2254

Location

United States

Related Subject Headings

  • Stroke
  • Severity of Illness Index
  • Sepsis
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Hospital Mortality