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Abstract
Objective To assess the frequency and predictors of unplanned readmissions after hospitalisation for incident atrial fibrillation (AF) and the association of readmissions with mortality over 2 years.
Methods We performed a retrospective cohort study using Western Australian morbidity and mortality data to identify all patients, aged 25–94 years, who survived incident (first-ever) hospitalisation for AF (principal diagnosis), between 2001 and 2015. Ordinal logistic models determined the covariates independently associated with unplanned readmission(s), and Cox proportional hazards models with time-varying exposures determined the hazard ratios (HR) of one or more readmissions for mortality over 2 years after incident AF.
Results Of 22 956 patients, 57.7% male, mean age 67.9 (SD 13.8) years, 44.0% experienced 22 053 unplanned readmissions within 2 years, 50.6% being cardiovascular-related. All-cause death occurred in 8.0% of the cohort, and the multivariable-adjusted mortality HR of 1 (vs 0) readmission was 2.9 (95% CI 2.6 to 3.3), increasing to 5.6 (95% CI 5.0 to 6.5) for 3+ readmissions. First emergent readmission for AF, stroke, heart failure or myocardial infarction was independently associated with an increased hazard for mortality. Coexistent cardiovascular and other comorbidities were independently associated with increased readmission and mortality risk, whereas AF ablation was associated with reduced risk.
Conclusion This study highlights the large burden of unplanned all-cause and cardiovascular-specific readmissions within 2 years after being hospitalised for incident AF and their associated adverse impact on mortality. Concomitant comorbidities are independently associated with unplanned hospitalisations and mortality, which supports integrated multidisciplinary management of comorbidities, along with AF-targeted treatments, to improve long-term outcomes in patients with AF.
- Atrial Fibrillation
- Epidemiology
- Risk Factors
- Outcome Assessment, Health Care
- Quality of Health Care
Data availability statement
Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. We will consider requests for data sharing on an individual basis, with the aim to share data whenever possible for appropriate research purposes. However, this research project uses data obtained from a third-party source under strict privacy and confidentiality agreements from the Western Australian Department of Health databases, which are governed by their ethics committee and data custodians. The data were provided after approval was granted from their standard application processes for access to the linked datasets. Therefore, any requests to share these data with other researchers will be subject to formal approval from the third-partyethics committees and data custodians. Researchers interested in these data should contact the Client Services Team at the Data Linkage Branch of the Western Australian Department of Health (http://www.datalinkage-wa.org.au/contact-us).
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Data availability statement
Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. We will consider requests for data sharing on an individual basis, with the aim to share data whenever possible for appropriate research purposes. However, this research project uses data obtained from a third-party source under strict privacy and confidentiality agreements from the Western Australian Department of Health databases, which are governed by their ethics committee and data custodians. The data were provided after approval was granted from their standard application processes for access to the linked datasets. Therefore, any requests to share these data with other researchers will be subject to formal approval from the third-partyethics committees and data custodians. Researchers interested in these data should contact the Client Services Team at the Data Linkage Branch of the Western Australian Department of Health (http://www.datalinkage-wa.org.au/contact-us).
Footnotes
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Contributors CW, JH, SH, IL and TB conceived the study. CW, JH and TB contributed to the study design and methods. CW performed the data and statistical analyses with statistical advice from KM. CW drafted the manuscript. CW, JH, SH, KM, IL and TB interpreted the results, provided critical review and approved the manuscript for submission. CW responsible for the overall content and is the guarantor of the work.
Funding CW is currently a PhD student with the UWA School of Population and Global Health, and is the recipient of a Postgraduate Scholarship from the National Health and Medical Research Council of Australia, Centre of Research Excellence in Cardiovascular Outcomes Improvement (# 1111170).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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