Atrial Fibrillation in Sepsis: Patient Outcomes and Provider Practice Patterns

描述(由申请人提供)：败血症是一种感染和全身炎症的综合征，是导致死亡的前十大原因，每年影响大约200万美国人，发病率不断上升。以脓毒症为特征的炎症、血流动力学和代谢异常也是房颤的已知触发因素和危险因素。房颤是一种心脏节律紊乱，其特征是丧失正常的心房收缩能力和快速心率。脓毒症是一种强烈的心房颤动触发因素的假设得到了 观察发现，患有严重脓毒症(与非严重脓毒症)住院的患者发生新发心房颤动的风险增加了6倍。重要的是，在严重脓毒症期间发生新发房颤的患者显著增加了住院期间死亡和中风的风险。在严重脓毒症期间发生房颤的患者中，超过1/2的患者无法存活到出院。目前尚无数据可用于预测脓毒症相关的新发房颤患者的长期预后。此外，几乎没有证据表明脓毒症期间复杂的房颤治疗决定的风险和益处。与…一致 国家心肺和血液研究所的使命是促进心肺和血液疾病的预防和治疗，目前的提案将使用补充的行政索赔数据来源来确定长期结果，并比较与脓毒症期间新发的心房颤动相关的实践模式的有效性。通过导师职业发展奖，候选人将发展过渡到独立研究职业所需的技能，包括高级流行病学方法、卫生服务/结果/观察性比较有效性研究方法、高级生物统计学/数据管理技术的培训，以及领导力和写作专长的发展。拟议项目产生的信息将为进一步的比较有效性和疗效试验提供信息，这些试验旨在直接为脓毒症期间的心房颤动患者的临床决策提供信息。此外，在获奖期间学到的职业发展和培训技能将使候选人能够在目前可用于脓毒症患者研究的有限数据来源的基础上进行建设和扩展。

DESCRIPTION (provided by applicant): 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.