Risk Factors for New-Onset Atrial Fibrillation in Critically Ill Septic Patients

Tuesday, March 24, 2026

11:15 AM - 12:15 PM Central Time

Location: Connections Central - RST 04

Essilvo Sulejmani, PharmD

The Ohio State University Wexner Medical Center, Ohio

Disclosure(s): No relevant financial relationship(s) to disclose.
Kate Harding, PharmD

Ohio State University

Disclosure(s): No relevant financial relationship(s) to disclose.
AG

Anthony Gerlach, PharmD, FCCM

Ohio State University Wexner Medical Center, Ohio

Disclosure information not submitted.
JA

Joshua Arnold, PharmD, BCCCP

Critical Care Specialty Practice Pharmacist
The Ohio State University Wexner Medical Center

Disclosure information not submitted.
bm

brookeAnne magrum, PharmD, BCCCP

Critical Care Specialty Practice Pharmacist
The Ohio State University Wexner Medical Center

Disclosure information not submitted.
AS

Adam Smith, PharmD, BCCCP

Critical Care Specialty Practice Pharmacist
The Ohio State University Wexner Medical Center

Disclosure information not submitted.
PG

Paul Gage, PharmD Candidate

pharmacy student
The Ohio State College of Pharmacy

Disclosure information not submitted.
MW

Megan Wang, PharmD Candidate

pharmacy student
The Ohio State College of Pharmacy

Disclosure information not submitted.
SO

Stella Ogake, MD, FCCP

Assistant Professor of Clinical Medicine Associate Program Director, Pulmonary and Critical Care Med
The Ohio State Wexner Medical Center

Disclosure information not submitted.
BD

Bruce Doepker, PharmD, BCPS

Critical Care Specialty Practice Pharmacist
The Ohio State University Wexner Medical Center

Disclosure information not submitted.

Introduction: New-onset atrial fibrillation (NOAF) in critically ill patients is associated with worse clinical outcomes, including extended hospital stays and mortality. While NOAF risk factors are well characterized in the outpatient setting, they remain incompletely understood in the critically ill. The purpose of this study is to identify risk factors for NOAF development in the critically ill patients with sepsis.

Methods: This single-center, retrospective study included adult patients with sepsis admitted to the medical or surgical intensive care unit (ICU) between September 2019-2024. Patients were classified into two groups: those who developed NOAF and those that did not [absence of AF (AAF)]. Data collected included: demographics, medical history, degree of shock, and organ dysfunction. Secondary outcomes were time to first AF episode, ICU length of stay, and inpatient mortality. Univariate methods were used to identify potential risk factors, and a multivariable modified Poisson regression model was subsequently used to estimate and adjust risk for these factors.

Results: There were 199 patients included: 56 NOAF and 143 AAF patients. NOAF patients had a higher body mass index (BMI), (31.2 vs 25.7, p < 0.001) and median norepinephrine equivalents (0.2 vs 0.12, p=0.32) at AF onset when compared to 48 hours post ICU admission in the AAF group. The median time to AF onset was 19.5 hours in the NOAF group. NOAF patients had a higher heart rate (141 vs 89 bpm, p< 0.001), acute kidney injury (71.4 vs 34.2%, p< 0.001), renal replacement therapy (26.7 vs 7.7%, p< 0.001), and mechanical ventilation (46.4 vs 23.8%, p=0.003). NOAF was associated with a longer ICU stay (7 vs 3 days, p < 0.001) and higher incidence of inpatient mortality (41.1 vs 15.4%, p < 0.001). The adjusted multivariable logistic regression found that age [relative risk (RR)=1.04, p=0.0007)], BMI (RR=1.04, p=0.0011), AKI (RR=2.4, p=0.0035), and mechanical ventilation (RR=1.91, p=0.017) remained strongly associated with development of NOAF in critically ill septic patients.

Conclusions: Age, BMI, acute kidney injury, and need for mechanical ventilation were found to be risk factors for NOAF development in critically ill septic patients even after adjusting for each other. Further multi-center prospective studies are needed.