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
Walkey, Allan J; Evans, Stephen R; Winter, Michael R et al. (2016) Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis: A Propensity-Matched Cohort Study. Chest 149:74-83
Walkey, Allan J; Weinberg, Janice; Wiener, Renda Soylemez et al. (2016) Association of Do-Not-Resuscitate Orders and Hospital Mortality Rate Among Patients With Pneumonia. JAMA Intern Med 176:97-104
Mehta, Anuj B; Douglas, Ivor S; Walkey, Allan J (2016) Hospital Noninvasive Ventilation Case Volume and Outcomes of Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 13:1752-1759
Fawzy, Ashraf; Bradford, Mark; Lindenauer, Peter K et al. (2016) Identifying Vasopressor and Inotrope Use for Health Services Research. Ann Am Thorac Soc 13:414-8
Vail, Emily A; Gershengorn, Hayley B; Hua, May et al. (2016) Epidemiology of Vasopressin Use for Adults with Septic Shock. Ann Am Thorac Soc 13:1760-1767
Mehta, Anuj B; Cooke, Colin R; Wiener, Renda Soylemez et al. (2016) Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study. Crit Care Med 44:1506-14
Walkey, Allan J; Bor, Jacob (2015) Risk-based Heterogeneity of Treatment Effect in Trials and Implications for Surveillance of Clinical Effectiveness Using Regression Discontinuity Designs. Am J Respir Crit Care Med 192:1399
Walkey, Allan J; Hogarth, D Kyle; Lip, Gregory Y H (2015) Optimizing atrial fibrillation management: from ICU and beyond. Chest 148:859-64
Walkey, Allan J; Lagu, Tara; Lindenauer, Peter K (2015) Trends in sepsis and infection sources in the United States. A population-based study. Ann Am Thorac Soc 12:216-20
Lubitz, Steven A; Yin, Xiaoyan; Rienstra, Michiel et al. (2015) Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. Circulation 131:1648-55

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