Author + information
- Osama Tariq Niazi,
- Ahmad Alkhalil,
- Adebayo Olusanya,
- Shashank Jain,
- Shervin Golbari,
- Riju Banerjee,
- Luke Chong,
- Victor Mazza,
- Marc Klapholz and
- Alfonso Waller
Background: The presence of atrial tachyarrhythmias has been studied in critically ill patients. However, little evidence is available about patients with septic shock. This subgroup of patients poses a challenge to management, as the use of vasopressors can exacerbate atrial arrhythmias. We sought to identify whether the presence of atrial fibrillation and atrial flutter (AF) was associated with an increase in hospital length of stay, cost and mortality.
Methods: Using the Nationwide Inpatient Sample (NIS) database and the specific International Classification of Diseases (ICD-9) codes we identified 436,406 patients admitted to the hospital from 2004 to 2012 with the principal diagnosis of septic shock. We divided this sample into two groups: patients with secondary diagnosis of AF after excluding any other supraventricular or ventricular arrhythmias (AF group, n=97021), and patients without AF (n=339385). Patient demographics, comorbidities, length of stay, cost of hospitalization and in-hospital mortality were identified and analyzed. Using the propensity score matching method using 39 covariates, two matched groups were derived with total of 97021 paired matches. Outcomes between the groups were compared.
Results: The prevalence of AF in patients with septic shock was 22.2%. At baseline compared to NAF, AF group was significantly older (p<0.001) and tended to have more comorbidities. Comparison between the two groups revealed a higher in-hospital mortality in the AF group (43.3% vs. 38.1%, p<0.001), longer median length of stay by one day (p<0.001) and a higher rate of in-hospital ischemic strokes (p<0.001). After propensity score matched analysis, AF group continued to have a higher mortality (43.3% vs. 42.4%, p<0.001), 1 day longer length of stay (p<0.001), more in-hospital ischemic strokes (2.8% vs. 2.5%, p<0.001) and a higher index hospitalization cost ($78399 vs. $68530, p<0.001).
Conclusions: Our retrospective propensity matched 9 year analysis of patients who presented to the hospital with the diagnosis of septic shock with and without AF found that AF was associated with an increase of in-hospital mortality, in-hospital stroke, length of stay and in-hospital costs.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Incorporating Novel Risks Toward Decision Making
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1280-110
- 2017 American College of Cardiology Foundation