Approximately 6-20% of patients with severe sepsis develop new-onset atrial fibrillation (AF).  Although the risks of chronic AF are well documented, the relationship between new-onset AF in the setting of sepsis and prognosis has not previously been well studied, partly due to the complex nature of this group of patients.

Using a database of patients hospitalised with severe sepsis, Walkey et al. examined the in-hospital stroke and mortality rates of patients developing new-onset AF.  Severe sepsis (n=49,082) was defined according to ICD-9-CM 995.92.  Cases of AF present at admission were excluded.

The authors found that new-onset AF occurred in 5.9% of patients with severe sepsis.  When these patients were compared with severe sepsis patients without new-onset AF, they were noted to have a greater risk of in-hospital stroke (2.6% vs 0.6%; P<0.001) and in-hospital mortality (56% vs 39%; P<0.001).  These findings persisted after sensitivity analysis and adjustment for confounding variables.

Conclusions:

New-onset AF in patients with severe sepsis indicates a group at increased risk of in-hospital stroke and death.

• Walkey AJ, Wiener RS, Ghobrial JM et al.  Incident Stroke and Mortality Assocaited With New-Onset Atrial Fibrillation in Patients Hospitalised With Severe Sepsis.  JAMA 2011.  Doi: 10.1001/jama.2011.1615