Large clinical study explores link between sepsis and cardiac arrhythmias
Tuesday, January 30, 2018
We all know that feeling of our heart skipping a beat. These cardiac arrhythmias are common. Symptoms such as dizziness, palpitations and syncope are frequent complaints encountered by family physicians, internists and cardiologists.
But sudden cardiac death remains an important public health concern. Statistics from the Centers for Disease Control and Prevention (CDC) have estimated sudden cardiac death (SCD) rates at more than 600,000 per year. SCD remains a major cause of death in industrialized countries, about 20 percent of all U.S. deaths annually, despite advances in the treatment of ischemic heart disease, revascularization therapies and devices to detect and treat ventricular arrhythmias.
Some conditions, such as coronary artery disease, hypertension, diabetes, smoking, high cholesterol, obesity, high fat diets and excessive use of alcohol, can increase the chance of developing arrhythmias. But the cardiovascular system can also be compromised by sepsis and always affected by septic shock.
Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis have been limited, and most of the studies have analyzed data from single and multicenter cohorts.
An earlier study, for example, showed that 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.
In a recent study, researchers studied the link between severe sepsis with cardiac arrhythmias and explored how severe sepsis influenced the outcomes of atrial and ventricular arrhythmias. The study is the largest to use discharge diagnoses from the Nationwide Inpatient Sample (NIS) database to validate prevalence, trends, predictors and outcomes of different arrhythmias in the septic population.
The researchers examined the correlation between arrhythmias with severe sepsis by defining two groups: Group A with severe sepsis was compared to Group B without severe sepsis. They also identified variables related to cardiac arrhythmias.
The researchers used hospital discharge data from 2012. All patients 18 years or older were included in the study. A total of 30,712,524 NIS hospital discharges were included in the study, of which 1,756,965 (5.7 percent) had severe sepsis.
The study results revealed that severe sepsis was associated with a higher prevalence of atrial and ventricular arrhythmias (28 percent vs. 17 percent). Atrial fibrillation was the most prevalent arrhythmia overall, although it was more prevalent in the sepsis group (12 percent vs. 19 percent).
Severe sepsis increased the risk of arrhythmias. An independent link was demonstrated between advanced age, male sex, ischemic heart disease, diabetes mellitus, congestive heart failure, valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors with cardiac arrhythmias.
Patients with severe sepsis are at high risk of atrial and ventricular arrhythmias. Although possibly a signal that the severity of a pre-existing illness may be increasing, arrhythmias may independently increase mortality in septic patients.
These results indicate the need for further studies to identify predictors and mechanisms of arrhythmias in severe sepsis to help establish preventive and treatment strategies.
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