New-onset atrial fibrillation predicting for complicating cardiac adverse outcome in scrub typhus infection

Suk-Yong Jang, Ki-Woon Kang, Jun Hyung Kim, Bongyoung Kim, Jung Yeon Chin, Sang Hyun Park, Yu Jeong Choi, Kyung Tae Jung, Seong-Kyu Lee, Suk-Yong Jang, Ki-Woon Kang, Jun Hyung Kim, Bongyoung Kim, Jung Yeon Chin, Sang Hyun Park, Yu Jeong Choi, Kyung Tae Jung, Seong-Kyu Lee

Abstract

Background: Scrub typhus is a well-known infectious disorder of the Asia-Pacific region. However, adverse cardiac outcomes are an under-recognized complication of scrub typhus infection, and new-onset AF has been reported to be a prognostic factor in other, more common infectious diseases. The present study investigated whether new-onset atrial fibrillation (AF) is significantly associated with 3-month mortality and adverse cardiac complications in scrub typhus infection.

Methods: We examined data from the National Health Information Database (NHID) which covers nearly the entire population of South Korea, from 2006 to 2016. In total, 233 473 patients diagnosed with scrub typhus infection were selected as study participants. New-onset AF, acute heart failure (AHF), ischemic heart disease (IHD), and 3-month mortality were analyzed using a generalized estimating equation model with a Poisson distribution.

Results: Of these, 2402 patients (1%) were diagnosed with new-onset AF (87.2% were over 60 years of age, 43.3% were male). Those with new-onset AF were more likely to have underlying cardiovascular disease compared to those without new-onset AF. After being adjusted for demographic factors and comorbidities, those with new-onset AF had a higher incidence risk of concurrent AHF (4.1-fold) and IHD (1.9-fold) compared with those without new-onset AF. In particular, the 3-month mortality was also significantly associated with new-onset AF (1.3-fold), concurrent AHF (2.4-fold), and IHD (13.7-fold).

Conclusions: New-onset AF was significantly associated with 3-month mortality and concurrent AHF and IHD. Therefore, new-onset AF could be a poor prognostic factor for 3-month mortality and cardiac complications in scrub typhus infection.

Keywords: Atrial fibrillation; Heart failure; Ischemic heart disease; Scrub typhus.

Conflict of interest statement

The authors declare no potential conflict of interests.

© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Comparison of survival rate free from, A, acute heart failure, B, ischemic heart disease, C, all‐cause mortality in patients diagnosed as scrub typhus between with and without new‐onset atrial fibrillation (NAF)

References

    1. Sittiwangkul R, Pongprot Y, Silviliarat S, Oberdorfer P, Jittamala P, Sirisanthana V. Acute fulminant myocarditis in scrub typhus. Ann Trop Paediatr. 2008;28(2):149‐154.
    1. Weitzel T, Dittrich S, Lopez J, et al. endemic scrub typhus in South America. N Engl J Med. 2016;375(10):954‐961.
    1. Walker DH. Scrub typhus ‐ Scientific neglect, ever‐widening impact. N Engl J Med. 2016;375(10):913‐915.
    1. Peter JV, Sudarsan TI, Prakash JA, Varghese GM. Severe scrub typhus infection: clinical features, diagnostic challenges and management. World J Crit Care Med. 2015;4(3):244‐250.
    1. Wang CC, Liu SF, Liu JW, Chung YH, Su MC, Lin MC. Acute respiratory distress syndrome in scrub typhus. Am J Trop Med Hyg. 2007;76(6):1148‐1152.
    1. Thap LC, Supanaranond W, Treeprasertsuk S, Kitvatanachai S, Chinprasatsak S, Phonrat B. Septic shock secondary to scrub typhus: characteristics and complications. Southeast Asian J Trop Med Public Health. 2002;33(4):780‐786.
    1. Parola P, Miller RS, McDaniel P, et al. Emerging rickettsioses of the Thai‐Myanmar border. Emerg Infect Dis. 2003;9(5):592‐595.
    1. Lee CS, Hwang JH, Lee HB, Kwon KS. Risk factors leading to fatal outcome in scrub typhus patients. Am J Trop Med Hyg. 2009;81(3):484‐488.
    1. Taylor AJ, Paris DH, Newton PNA. Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis. 2015;9(8):e0003971.
    1. Moss TJ, Calland JF, Enfield KB, et al. New‐onset atrial fibrillation in the critically ill. Crit Care Med. 2017;45(5):790‐797.
    1. Chin JY, Kang KW, Moon KM, Kim J, Choi YJ. Predictors of acute myocarditis in complicated scrub typhus: an endemic province in the Republic of Korea. Korean J Intern Med. 2018;33:323‐330.
    1. Chung WS, Lin CL, Hsu WH, Kao CH. Scrub typhus increases the risk of developing acute coronary syndrome: a nationwide cohort study. Heart. 2014;100(23):1844‐1850.
    1. Freiberg MS, Chang CH, Skanderson M, et al. Association between HIV infection and the risk of heart failure with reduced ejection fraction and preserved ejection fraction in the antiretroviral therapy era: results from the Veterans Aging Cohort Study. JAMA Cardiol. 2017;2(5):536‐546.
    1. Cheol Seong S, Kim YY, Khang YH, et al. Data resource profile: The National Health Information Database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2017;46(3):799‐800.
    1. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD‐9‐CM and ICD‐10 administrative data. Med Care. 2005;43(11):1130‐1139.
    1. Warren‐Gash C, Smeeth L, Hayward AC. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. Lancet Infect Dis. 2009;9(10):601‐610.
    1. Freiberg MS, Chang CC, Kuller LH, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173(8):614‐622.
    1. Walkey AJ, Benjamin EJ, Lubitz SA. New‐onset atrial fibrillation during hospitalization. J Am Coll Cardiol. 2014;64(22):2432‐2433.
    1. Klein Klouwenberg PM, Frencken JF, Kuipers S, et al. Incidence, predictors, and outcomes of new‐onset atrial fibrillation in critically ill patients with sepsis. A cohort study. Am J Respir Crit Care Med. 2017;195(2):205‐211.
    1. Arrigo M, Ishihara S, Feliot E, et al. New‐onset atrial fibrillation in critically ill patients and its association with mortality: A report from the FROG‐ICU study. Int J Cardiol. 2018;266:95‐99.
    1. Allen AC, Spitz SA. Comparative study of the pathology of scrub typhus (tsutsugamushi disease) and other rickettsial diseases. Am J Pathol. 1945;21(4):603‐681.
    1. Issac TT, Dokainish H, Lakkis NM. Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data. J Am Coll Cardiol. 2007;50(21):2021‐2028.
    1. Aviles RJ, Martin DO, Apperson‐Hansen C, et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003;108(24):3006‐3010.
    1. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow‐up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012;9(4):632‐696. e621.
    1. Mountantonakis SE, Grau‐Sepulveda MV, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC. Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines‐heart failure. Circ Heart Fail. 2012;5(2):191‐201.
    1. Anter E, Jessup M, Callans DJ. Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation. 2009;119(18):2516‐2525.
    1. Adegbala O, Olagoke O, Akintoye E, et al. Predictors, burden, and the impact of arrhythmia on patients admitted for acute myocarditis. Am J Cardiol. 2019;123(1):139‐144.
    1. Michniewicz E, Mlodawska E, Lopatowska P, Tomaszuk‐Kazberuk A, Malyszko J. Patients with atrial fibrillation and coronary artery disease ‐ double trouble. Adv Med Sci. 2018;63(1):30‐35.
    1. Corrales‐Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis. 2010;10(2):83‐92.
    1. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J. 2009;30(9):1038‐1045.
    1. Deluigi CC, Ong P, Hill S, et al. ECG findings in comparison to cardiovascular MR imaging in viral myocarditis. Int J Cardiol. 2013;165(1):100‐106.
    1. Kindermann I, Barth C, Mahfoud F, et al. Update on myocarditis. J Am Coll Cardiol. 2012;59(9):779‐792.
    1. Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373(10):929‐938.

Source: PubMed

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