This federated database study compared adults with septic shock with versus without preexisting atrial fibrillation or flutter, matching 76,295 patients per group. Preexisting arrhythmia was associated with higher 30-day mortality (RR 1.07, 95% CI 1.06–1.09). Associations were also observed for renal replacement therapy (RR 1.30, 95% CI 1.25–1.35), invasive mechanical ventilation (RR 1.14, 95% CI 1.12–1.16), and vasopressor/inotrope use (RR 1.09, 95% CI 1.08–1.10). Cerebral infarction did not differ significantly (RR 1.11, 95% CI 1.00–1.24; P=0.054), which does not establish equivalent risk.
Preexisting AF/flutter was associated with modestly higher mortality and greater organ-support use in septic shock. These findings support prognostic relevance, not a causal effect or treatment change.
Study limitation: Propensity matching cannot exclude residual confounding, and this observational comparison does not establish causation.
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