Background: New-onset atrial fibrillation (NOAF) is a common complication in patients with sepsis, although its prevalence and impact on outcomes are still unclear. We aim to provide a systematic review and meta-analysis on the prevalence of NOAF in patients with sepsis, and its impact on in-hospital mortality and intensive care unit (ICU) mortality. Methods: PubMed and EMBASE were systematically searched on 26 December 2021. Studies reporting on the prevalence of NOAF and/or its impact on in-hospital mortality or ICU mortality in patients with sepsis or septic shock were included. The pooled prevalence and 95% confidence intervals (CI) were calculated, as well as the risk ratios (RR), 95%CI and 95% prediction intervals (PI) for outcomes. Subgroup analyses and meta-regressions were performed to account for heterogeneity. Results: Among 4988 records retrieved from the literature search, 22 articles were included. Across 207,847 patients with sepsis, NOAF was found in 13.5% (95%CI: 8.9–20.1%), with high heterogeneity between studies; significant subgroup differences were observed, according to the geographical location, study design and sample size of the included studies. A multivariable meta-regression model showed that sample size and geographical location account for most of the heterogeneity. NOAF patients showed an increased risk of both in-hospital mortality (RR: 1.69, 95%CI: 1.47–1.96, 95%PI: 1.15–2.50) and ICU mortality (RR: 2.12, 95%CI: 1.86–2.43, 95%PI: 1.71–2.63), with moderate to no heterogeneity between the included studies. Conclusions: NOAF is a common complication during sepsis, being present in one out of seven individuals. Patients with NOAF are at a higher risk of adverse events during sepsis, and may need specific therapeutical interventions.

/pdf/prevalence-of-new-onset-atrial-fibrillation-and-associated-cyk1j78i.pdf

Prevalence of New-Onset Atrial Fibrillation and Associated Outcomes in Patients with Sepsis: A Systematic Review and Meta-Analysis

Atrial fibrillation (AF) is the most common arrhythmia in the setting of critically ill patients. Pneumonia, and in particular community-acquired pneumonia, is one of the most common causes of illness and hospital admission worldwide. This article aims to review the association between AF and acute diseases, with specific attention to pneumonia, from the pathophysiology to its clinical significance. Even though the relationship between pneumonia and AF has been known for years, it was once considered a transient bystander. In recent years there has been growing knowledge on the clinical significance of this arrhythmia in acute clinical settings, in which it holds a prognostic role which is not so different as compared to that of the so-called "primary" AF. AF is a distinct entity even in the setting of pneumonia, and acute critical illnesses in general, and it should therefore be managed with a guidelines-oriented approach, including prescription of anticoagulants in patients at thromboembolic risk, always considering patients' individuality. More data on the significance of the arrhythmia in this setting will help clinicians to give patients the best possible care.

Atrial Fibrillation in the Setting of Acute Pneumonia: Not a Secondary Arrhythmia

Atrial fibrillation (AF) is a very common in clinical practice. The prevalence of AF is high after the age of 65 years. Patients with AF have a worse quality of life than healthy controls. However, concomitant higher hemorrhagic risks, severe cognitive and functional impairment may at least partly explain under-prescription of oral anticoagulants in the elderly.

/pdf/atrial-fibrillation-all-the-elderly-go-hospitalized-a-9qm2srx1j2.pdf

Atrial fibrillation: all the elderly go hospitalized? A minireview

Atrial fibrillation (AF), the commonest sustained cardiac arrhythmia affecting the adult population, is often casually discovered among hospitalized people. AF onset is indeed triggered by several clinical conditions such as acute inflammatory states, infections, and electrolyte disturbance, frequently occurring during the hospitalization. We aimed to evaluate whether systematic AF screening, performed through an automated oscillometric blood pressure (BP) device (Microlife WatchBP Office AFIB, Microlife AG, Switzerland), is effective for detecting AF episodes in subjects admitted to an Internal Medicine ward. 163 patients consecutively hospitalized at the Unit of Internal Medicine of the “Santa Maria” Terni University Hospital between November 2019 and January 2020 (mean age ± standard deviation: 77 ± 14 years, men proportion: 40%) were examined. Simultaneously with BP measurement and AF screening, a standard 12-lead electrocardiogram (ECG) was performed in all subjects. AF was diagnosed by ECG in 29 patients (18%). AF screening showed overall 86% sensitivity and 96% specificity. False negatives (n = 4) had RR-interval coefficient of variation lower than true positives (n = 25, p < 0.01), suggesting a regular ventricular rhythm during AF. The repeated evaluation substantially confirmed the same level of agreement. AF screening was positive in all patients with new-onset AF (n = 6, 100%). Systematic AF screening in patients admitted to Internal Medicine wards, performed using the Microlife WatchBP Office AFIB, is feasible and effective. The opportunity to implement such technology in daily routine clinical practice to prevent undiagnosed AF episodes in hospitalized patients should be the subject of further research.

/pdf/screening-for-atrial-fibrillation-during-automated-blood-4h1hmdsmse.pdf

Screening for atrial fibrillation during automated blood pressure measurement among patients admitted to internal medicine ward

Introducción: la fibrilación auricular es la arritmia cardíaca más frecuente a nivel mundial, considerándose un problema importante de salud pública dada su elevada morbimortalidad y alta carga económica asociada al ataque cerebrovascular como su principal complicación tromboembólica.Objetivo: hacer una revisión narrativa de los aspectos fisiopatológicos, factores de riesgo y de la terapia anticoagulante oral en pacientes con fibrilación auricular. Métodos: utilizando las palabras claves se realizó una revisión no sistemática de la literatura disponible, tanto en inglés como en español, en las bases de datos PubMed, Science Direct, Embase, EBSCO y MEDLINE. Se seleccionaron 68 publicaciones entre ellas guías de práctica clínica, metaanálisis, revisiones sistemáticas, ensayos clínicos y artículos originales que daban respuesta a nuestro objetivo con la mejor evidencia posible. Resultados: en el inicio y mantenimiento de la fibrilación auricular participan factores de riesgos modificables y no modificables, los cuales inciden en su fisiopatología generando tanto trastornos de la formación del impulso como trastornos de la conducción. En las últimas décadas los anticoagulantes orales directos han comprobado igual o mayor beneficio que la warfarina, con menores tasas de efectos adversos en pacientes con fibrilación auricular no valvular. Incluso, algunos estudios sugieren la extensión de uso en fibrilación auricular valvular. Sin embargo, la warfarina sigue siendo el fármaco de elección con mayor evidencia en esta última. Conclusión: la fibrilación auricular es una arritmia cuya incidencia va en aumento dado la mayor prevalencia de factores de riesgo en la población. La anticoagulación es un pilar en la prevención del ataque cerebrovascular. Debe instaurarse con un enfoque individualizado teniendo en cuenta los efectos adversos y beneficios de cada fármaco, el perfil del paciente, el riesgo de ataque cerebrovascular y el riesgo de hemorragia mediante el uso de escalas. 

/pdf/fibrilacion-auricular-fisiopatologia-factores-de-riesgo-y-1jwxmmtd.pdf

Fibrilación auricular: fisiopatología, factores de riesgo y rol de la anticoagulación oral

Atrial fibrillation (AF) is a frequent pathology in Internal Medicine departments. The aim of our study was to identify the risk factors associated with the development of new-onset AF during hospitalization and to evaluate its outcome as in-hospital mortality. We conducted a retrospective case–control study on a cohort of 14,179 patients admitted to an internal medicine department. We included in the study the patients who did not have an anamnestic history of AF, who presented a sinus rhythm at the time of admission and who developed a new-onset AF during hospitalization. For each of these cases, two controls were enrolled who were not affected by AF. The patients included in the study were 588, including 196 cases and 392 controls. Patients who developed AF during hospitalization had significantly more comorbidity than controls. The most frequent causes for hospitalization were sepsis, significantly higher in the case group. From the results of the multivariate analysis, the factors related independently to the development of AF were the presence of a number of comorbidities ≥ 3 (OR = 1.52; p = 0.017), sepsis as a reason of hospitalization (OR = 2, 16; p = 0.001) and glycemic value at the admission ≥ 130 mg/dL (OR = 1.44; p = 0.047). Both the length of hospital stay and in-hospital mortality were higher in the group of patients who developed AF, with a statistically significant difference compared to controls (p < 0.001).

Risk factors and outcomes of new-onset atrial fibrillation in patients hospitalized in an internal medicine ward: a case–control study

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Risk factors and outcomes of new-onset atrial fibrillation in patients hospitalized in an internal medicine ward: a case–control study