CHEST Guidelines-Slow-and-Study

Slow-and-Study_chest

Pdf Summary

The document is an editorial by Matthew W. Semler and Arthur P. Wheeler discussing a study by Walkey et al., which analyzes the use of b-blockers in treating atrial fibrillation (AF) during sepsis. Nearly one in four of the 1 million patients hospitalized for sepsis in the U.S. annually experience AF. Despite the long-standing use of b-blockers, calcium channel blockers, digoxin, and amiodarone, the impact of these medications on outcomes has not been previously studied.<br /><br />Walkey et al.'s study, utilizing administrative data between 2010-2013, found that among patients hospitalized for sepsis, AF occurred in 20%, with 35% of these receiving intravenous therapy. The most common initial treatment was calcium channel blockers, followed by b-blockers, digoxin, and amiodarone. The choice of therapy was influenced by patient characteristics, geographic regions, and hospital characteristics. However, b-blockers were associated with lower in-hospital mortality compared to other treatments, even when adjusted for confounding factors such as patient characteristics and hospital practices.<br /><br />The editorial highlights that retrospective studies like Walkey et al.'s have inherent limitations, such as potential confounding by indication bias. Despite this, the study's findings suggest a shift towards b-blockers for AF treatment during sepsis might improve outcomes. This is biologically plausible because AF in sepsis is often triggered by catecholamines and inflammation, and b-blockers are effective in similar contexts like cardiac surgery and hyperthyroidism.<br /><br />Semler and Wheeler recommend further randomized clinical trials to validate these findings and stress the need for rigorous testing of common interventions for conditions like sepsis-associated AF, as even small improvements in mortality rates could potentially save thousands of lives annually.

Keywords

atrial fibrillation

sepsis

b-blockers

mortality

Walkey study

calcium channel blockers

digoxin

amiodarone

retrospective study

randomized clinical trials