Sepsis is a syndrome of infection and systemic inflammation that is a top 10 cause of death with increasing incidence affecting approximately 2 million Americans yearly. The inflammatory, hemodynamic, and metabolic abnormalities that characterize sepsis are also known triggers and risk factors for atrial fibrillation. Atrial fibrilation is a heart rhythm disturbance characterized by a loss of normal atrial contractility and rapid heart rates. The hypothesis that sepsis is a strong atrial fibrillation trigger is supported by the observation that patients hospitalized with severe sepsis (vs. non-severe sepsis) have a 6-fold increased risk of developing new-onset atrial fibrillation. Importantly, patients who develop new-onset AF during severe sepsis have significantly increased risk for in-hospital death and stroke. More than 1/2 of patients who develop atrial fibrillation during severe sepsis do not survive to hospital discharge. No data are available for prognostication of long term outcomes in patients with sepsis-associated, new-onset atrial fibrillation. Further, little evidence exists to weigh riss and benefits of complicated treatment decisions for atrial fibrillation during sepsis. In line with the National Heart, Lung, and Blood Institute's mission to promote the prevention and treatment of heart, lung, and blood disease, the current proposal will use complementary administrative claims data sources to determine long-term outcomes and compare effectiveness of practice patterns associated with new-onset atrial fibrillation occurring during sepsis. Through the Mentored Career Development Award, the candidate will develop skills necessary for transition to an independent research career, including training in advanced epidemiologic methods, health services/outcomes/observational comparative effectiveness research methods, advanced biostatistics/data management techniques, and development of leadership and writing expertise. The information produced from the proposed project will inform further comparative effectiveness and efficacy trials designed to directly inform clinical decisions for patients with atrial fibrillation during sepsis. In addition, the career development and training skills learned during the award will allow the candidate to build and expand upon the currently limited data sources available for the study of patients with sepsis.

Public Health Relevance

Sepsis is a syndrome of infection and systemic inflammation that affects nearly 2 million Americans each year. Atrial fibrillation - a cardiac rhythm disorder characterized by loss of normal atrial contraction, rapid heart rates, and increased risk for strok - frequently occurs during sepsis. Utilizing existing administrative data, the research program will determine the long-term prognosis of patients who have atrial fibrillation during sepsis and explore treatment strategies with the potential to improve outcomes for patients with atrial fibrillation during sepsis.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
1K01HL116768-01
Application #
8425628
Study Section
Special Emphasis Panel (ZHL1-CSR-K (O2))
Program Officer
Bonds, Denise
Project Start
2013-02-12
Project End
2018-01-31
Budget Start
2013-02-12
Budget End
2014-01-31
Support Year
1
Fiscal Year
2013
Total Cost
$133,949
Indirect Cost
$9,922
Name
Boston University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Stevenson, Elizabeth K; Rubenstein, Amanda R; Radin, Gregory T et al. (2014) Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med 42:625-31
Mehter, Hashim M; Wiener, Renda Soylemez; Walkey, Allan J (2014) "Do not resuscitate" decisions in acute respiratory distress syndrome. A secondary analysis of clinical trial data. Ann Am Thorac Soc 11:1592-6
Walkey, Allan J; Hammill, Bradley G; Curtis, Lesley H et al. (2014) Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest 146:1187-95
Munshi, Laveena; Walkey, Allan; Fan, Eddy (2014) Reply: extracorporeal life support. Ann Am Thorac Soc 11:993
Walkey, Allan J (2014) Preventing cardiovascular complications of acute infection: a missed opportunity? Circulation 129:1375-7
Walkey, Allan J (2014) Expanding the dimensions of effectiveness research in sepsis. Am J Respir Crit Care Med 190:970-1
Bradford, Mark A; Lindenauer, Peter K; Wiener, Renda Soylemez et al. (2014) Do-not-resuscitate status and observational comparative effectiveness research in patients with septic shock*. Crit Care Med 42:2042-7
Munshi, Laveena; Telesnicki, Teagan; Walkey, Allan et al. (2014) Extracorporeal life support for acute respiratory failure. A systematic review and metaanalysis. Ann Am Thorac Soc 11:802-10
Walkey, Allan J; Wiener, Renda Soylemez (2014) Hospital case volume and outcomes among patients hospitalized with severe sepsis. Am J Respir Crit Care Med 189:548-55
Walkey, Allan J; Wiener, Renda Soylemez (2014) Trends in infection source and mortality among patients with septic shock. Am J Respir Crit Care Med 190:709-10

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