Abstract
Background: Increased awareness of the importance of timely treatment of sepsis has led to improved sepsis care and outcomes over time in the USA. Research question: We evaluated the prevalence of atrial fibrillation (AF) and atrial flutter (AFL) in septic patients over time. Aims: The primary objective was to evaluate temporal trends in the prevalence of AF and AFL in septic patients. The secondary objective was to evaluate these trends stratified by age, sex, and race and ethnicity. Methods: Using the National Inpatient Sample, we studied all adult patients hospitalized with sepsis in the USA from 2010 to 2019. The year 2015 was not included due to changes in ICD coding in the last quarter. Results: Of 18.4 million adult patients admitted with sepsis from 2010 to 2019 in the USA, with a mean age of 65±0.038 years, 50% were female. The risk-adjusted rates of AF and AFL in septic patients showed an increasing trend over time (Panel A) after accounting for differences in age, sex, and comorbidity burden. AF and AFL occurred more frequently in the elderly than the young (Panel B). Sex-stratified analysis showed consistently higher rates of AF and AFL in males than females throughout the study period (Panel C). Finally, the risk-adjusted rates of AF and AFL were consistently highest in White patients, followed by Asian patients, compared with other races and ethnicities throughout the study period (Panel D). Conclusion: Despite improved treatment of sepsis, as evidenced by improving outcomes shown by many studies, the prevalence of AF and AFL in patients with sepsis in the USA has increased over time. This is likely due to sicker patients with sepsis now than in the past or to residual confounding owing to an increase in the elderly and comorbid patient population, which is not captured completely by the comorbidity index. White and Asian patients with sepsis had higher rates of AF than other racial and ethnic groups.
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