Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis
Abstract Background The optimal management strategy for new-onset atrial fibrillation (NOAF) in patients with sepsis remains unclear. This study aimed to investigate and compare the associations of rhythm control medications versus rate control medications with mortality outcomes in septic patients...
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BMC
2025-05-01
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| Series: | Journal of Translational Medicine |
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| Online Access: | https://doi.org/10.1186/s12967-025-06380-y |
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| author | Cuilian Weng Jian Lin Qinghua Liu Chang-hong Zou Mingyu Zheng Tingting Jiang Linqian Jiang Xiao-Feng Zhuang Hangwei Feng |
| author_facet | Cuilian Weng Jian Lin Qinghua Liu Chang-hong Zou Mingyu Zheng Tingting Jiang Linqian Jiang Xiao-Feng Zhuang Hangwei Feng |
| author_sort | Cuilian Weng |
| collection | DOAJ |
| description | Abstract Background The optimal management strategy for new-onset atrial fibrillation (NOAF) in patients with sepsis remains unclear. This study aimed to investigate and compare the associations of rhythm control medications versus rate control medications with mortality outcomes in septic patients with NOAF. Methods This propensity score-matched cohort study utilized data from the Medical Information Mart in Intensive Care-IV database. Adult septic patients with NOAF were categorized into two groups based on initial medications (rhythm or rate control). The primary outcome was 28-day mortality, with secondary outcomes including intensive care unit(ICU),1-year mortality. Results A total of 586 patients were included in the prematched cohort, with 277 patients remaining after propensity score matching. In the matched cohort, the primary outcome of 28-day mortality rate was 49.7% (85/171) in the rate control group and 46.2% (49/106) in the rhythm control group, with no significant difference between the groups (HR 0.97; 95% CI 0.68-1.37,P = 0.849). Secondary outcomes showed that rhythm control medications were not associated with increased ICU mortality (HR 1.03, 95% CI 0.60–1.78, P = 0.906) or 1-year mortality (HR 0.84, 95% CI 0.61–1.16, P = 0.299).However, the rhythm control group had higher successful cardioversion rates compared to the rate control group at 6 h (68.9% vs. 49.1%, P = 0.001), 12 h (71.1% vs. 52.4%, P = 0.002), and 24 h (72.7% vs. 53.2%, P = 0.002). Conclusions In septic patients with NOAF, rhythm control and rate control medications showed no difference in 28-day, ICU, or 1-year mortality.However, rhythm control may provide transient hemodynamic stabilization through rapid cardioversion, potentially beneficial during acute critical illness. |
| format | Article |
| id | doaj-art-a8eeb4781128421da8e14ee2262ff4d8 |
| institution | Kabale University |
| issn | 1479-5876 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Translational Medicine |
| spelling | doaj-art-a8eeb4781128421da8e14ee2262ff4d82025-08-20T04:02:55ZengBMCJournal of Translational Medicine1479-58762025-05-0123111110.1186/s12967-025-06380-yComparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysisCuilian Weng0Jian Lin1Qinghua Liu2Chang-hong Zou3Mingyu Zheng4Tingting Jiang5Linqian Jiang6Xiao-Feng Zhuang7Hangwei Feng8Department of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital South BranchDepartment of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital South BranchDepartment of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Fujian Medical UniversityHeart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular DiseasesThe School of Basic Medical Sciences, Fujian Medical UniversityDepartment of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial South BranchDepartment of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital South BranchHeart Failure Care Unit, Heart Failure Center, Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular DiseasesDepartment of Intensive Care Unit, The Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital South BranchAbstract Background The optimal management strategy for new-onset atrial fibrillation (NOAF) in patients with sepsis remains unclear. This study aimed to investigate and compare the associations of rhythm control medications versus rate control medications with mortality outcomes in septic patients with NOAF. Methods This propensity score-matched cohort study utilized data from the Medical Information Mart in Intensive Care-IV database. Adult septic patients with NOAF were categorized into two groups based on initial medications (rhythm or rate control). The primary outcome was 28-day mortality, with secondary outcomes including intensive care unit(ICU),1-year mortality. Results A total of 586 patients were included in the prematched cohort, with 277 patients remaining after propensity score matching. In the matched cohort, the primary outcome of 28-day mortality rate was 49.7% (85/171) in the rate control group and 46.2% (49/106) in the rhythm control group, with no significant difference between the groups (HR 0.97; 95% CI 0.68-1.37,P = 0.849). Secondary outcomes showed that rhythm control medications were not associated with increased ICU mortality (HR 1.03, 95% CI 0.60–1.78, P = 0.906) or 1-year mortality (HR 0.84, 95% CI 0.61–1.16, P = 0.299).However, the rhythm control group had higher successful cardioversion rates compared to the rate control group at 6 h (68.9% vs. 49.1%, P = 0.001), 12 h (71.1% vs. 52.4%, P = 0.002), and 24 h (72.7% vs. 53.2%, P = 0.002). Conclusions In septic patients with NOAF, rhythm control and rate control medications showed no difference in 28-day, ICU, or 1-year mortality.However, rhythm control may provide transient hemodynamic stabilization through rapid cardioversion, potentially beneficial during acute critical illness.https://doi.org/10.1186/s12967-025-06380-yRhythm controlRate controlNew-onset atrial fibrillationSepsis |
| spellingShingle | Cuilian Weng Jian Lin Qinghua Liu Chang-hong Zou Mingyu Zheng Tingting Jiang Linqian Jiang Xiao-Feng Zhuang Hangwei Feng Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis Journal of Translational Medicine Rhythm control Rate control New-onset atrial fibrillation Sepsis |
| title | Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis |
| title_full | Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis |
| title_fullStr | Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis |
| title_full_unstemmed | Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis |
| title_short | Comparison of rhythm and rate control medications for new-onset atrial fibrillation in septic patients: MIMIC-IV database analysis |
| title_sort | comparison of rhythm and rate control medications for new onset atrial fibrillation in septic patients mimic iv database analysis |
| topic | Rhythm control Rate control New-onset atrial fibrillation Sepsis |
| url | https://doi.org/10.1186/s12967-025-06380-y |
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