Comparison of heart rate after phenylephrine versus norepinephrine initiation in patients with septic shock and atrial fibrillation

Chest. 2022 May 5:S0012-3692(22)00891-1. doi: 10.1016/j.chest.2022.04.147. Online ahead of print.ABSTRACTBACKGROUND: Atrial fibrillation (AF) is a common complication of sepsis. It is unclear if norepinephrine, an α- and β-agonist, and phenylephrine, an α-agonist, are associated with different heart rates among patients with sepsis and AF.RESEARCH QUESTION: Among patients with sepsis and AF, what is the difference in heart rate after phenylephrine initiation versus norepinephrine initiation?STUDY DESIGN AND METHODS: Using the Medical Information Mart in Intensive Care (MIMIC)-IV database, we identified patients with sepsis and AF at the time norepinephrine or phenylephrine initiation. We estimated the difference in heart rate between patients receiving phenylephrine or norepinephrine one and six hours after vasopressor initiation using multivariable-adjusted linear regression, tested for effect modification by heart rate, and stratified by baseline heart rate ≥110 or <110. Secondary outcomes included conversion to sinus rhythm, bradycardia, vasopressor duration, intensive care unit (ICU) and hospital length of stay, and hospital mortality. Exploratory analyses adjusted for practices occurring after vasopressor initiation; sensitivity analyses used interrupted time series to estimate the difference in average heart rate between patients receiving phenylephrine and norepinephrine.RESULTS: Among 1847 patients with sepsis and AF, 946 (51%) received norepinephrine and 901 ...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research