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Atrial Fibrillation Outcomes Presenting During Infections
Study Questions:
What is the subsequent incidence of recurrent atrial fibrillation (AF) and stroke in patients who present with infection-related AF?
Methods:
Patients with no prior diagnosis of AF who were hospitalized in 1996-2016 for an infection were identified from Danish administrative registries. Patients with AF during the hospitalization (Group I, n = 30,307) were matched 1:3 with patients without infection-related AF (Group II, n = 90,912) based on age, sex, type of infection, and year. Recurrent AF and thromboembolic events (TEs) during the first year post-hospitalization were analyzed.
Results:
The 1-year incidence of AF was 36.4% in Group I compared to 1.9% in Group II. The 1-year incidence of TEs was 7.6% in Group I compared to 4.4% in Group II. By multivariate analysis that adjusted for multiple comorbidities and concurrent pharmacologic treatment, infection-related AF was independently associated with a 26-fold higher risk of having recurrent AF and a 2.1-fold higher risk of having a TE.
Conclusions:
More than one-third of patients who present with infection-related AF continue to have AF after treatment of the infection.
Perspective:
A limitation of the study is that the rhythm diagnosis at the time of hospital discharge was not available and it is possible that at least some of the patients already were having undiagnosed episodes of AF before the infection. In any event, the results of this large-scale observational study confirm the findings of prior studies that have reported a higher risk of recurrent AF and TEs in patients with infection-related AF. The results emphasize the need for post-discharge extended ambulatory monitoring to detect subclinical episodes of AF in patients who have had infection-related AF.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Infections, Monitoring, Ambulatory, Patient Discharge, Secondary Prevention, Stroke, Thromboembolism
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