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.
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.
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| Walkey, Allan J; Shieh, Meng-Shiou; Liu, Vincent X et al. (2018) Mortality Measures to Profile Hospital Performance for Patients With Septic Shock. Crit Care Med 46:1247-1254 |
| Law, Anica C; Sahetya, Sarina; Walkey, Allan J et al. (2018) Low-dose corticosteroids and septic shock resolution: implications for randomized trial design? Intensive Care Med 44:1366-1367 |
| Law, Anica C; Stevens, Jennifer P; Hohmann, Samuel et al. (2018) Patient Outcomes After the Introduction of Statewide ICU Nurse Staffing Regulations. Crit Care Med 46:1563-1569 |
| Cohen, David M; Winter, Michael; Lindenauer, Peter K et al. (2018) Echocardiogram in the Evaluation of Hemodynamically Stable Acute Pulmonary Embolism: National Practices and Clinical Outcomes. Ann Am Thorac Soc 15:581-588 |
| Walkey, Allan J; Drainoni, Mari-Lynn; Cordella, Nicholas et al. (2018) Advancing Quality Improvement with Regression Discontinuity Designs. Ann Am Thorac Soc 15:523-529 |
| Lindenauer, Peter K; Shieh, Meng-Shiou; Stefan, Mihaela S et al. (2017) Hospital Procalcitonin Testing and Antibiotic Treatment of Patients Admitted for Chronic Obstructive Pulmonary Disease Exacerbation. Ann Am Thorac Soc 14:1779-1785 |
| Walkey, Allan J; Barnato, Amber E; Wiener, Renda Soylemez et al. (2017) Accounting for Patient Preferences Regarding Life-Sustaining Treatment in Evaluations of Medical Effectiveness and Quality. Am J Respir Crit Care Med 196:958-963 |
| Walkey, Allan J; McManus, David (2017) When Rhythm Changes Cause the Blues: New-Onset Atrial Fibrillation during Sepsis. Am J Respir Crit Care Med 195:152-154 |
| Mehta, Anuj B; Douglas, Ivor S; Walkey, Allan J (2017) Evidence-based Utilization of Noninvasive Ventilation and Patient Outcomes. Ann Am Thorac Soc 14:1667-1673 |
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