SESSION TITLE: Advances in Cardiac Disease
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 04:30 PM - 05:30 PM
PURPOSE: Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis are limited. We examine the association of severe sepsis with cardiac arrhythmias and their impact on outcome in this patient population.
METHODS: We used hospital discharge data from the Nationwide Inpatient Sample (NIS) from 2012. All patients 18 and older were included in the study. The International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) code was used to identify patients with discharge diagnosis of severe sepsis, atrial fibrillation, atrial flutter, ventricular fibrillation (VF) arrest and non-ventricular fibrillation (non-VF) arrest. To study the association of arrhythmias with severe sepsis, we defined two groups; a group with severe sepsis was compared to a group without severe sepsis. We used univariate and multivariate logistic regression methods to adjust for potential confounding factors and determined variables associated with cardiac arrhythmias.
RESULTS: A total of 30,712,524 NIS hospital discharges (weighted for national estimate) were included in our study, of which 1,756,965 (5.7%) had severe sepsis. On multivariate analysis, after adjusting for potential confounders, severe sepsis was associated with higher prevalence of atrial fibrillation (OR 1.23; 95% CI 1.21-1.24), atrial flutter (OR 1.34; CI 1.30-1.40), VF arrest (OR 2.58; CI 2.38-2.79) (OR 3.31; CI 3.07-3.57) and non-VF arrest (OR 4.91; 4.74-5.07). In the severe sepsis group cardiac arrhythmia was associated with higher in-hospital mortality (OR 1.41; 95% CI 1.37-1.45), length of stay >75% quartile (OR 1.50; CI 1.46-1.53) and total hospital charges >75% quartile (OR 1.37; CI 1.34-1.41). Advanced age, male sex, ischemic heart disease, diabetes mellitus, congestive heart failure, valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors were independently associated with cardiac arrhythmias.
CONCLUSIONS: Patients with severe sepsis are at high risk of atrial and life-threatening ventricular arrhythmias. Despite adjustment for potential confounding factors, patients hospitalized with severe sepsis carry significantly higher risk for cardiac arrest and increased mortality.
CLINICAL IMPLICATIONS: Increased risk of life-threatening ventricular arrhythmias associated with severe sepsis warrants closer monitoring and highlights a need for developing preventive strategies, which could lead to better outcomes in this population.
DISCLOSURE: The following authors have nothing to disclose: Krishna Thandra, Jawad Hussain, Muhammad Shahreyar, Sanjay Bhandari, Atul Thakur, Geetanjali Dang, Arshad Jahangir
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