Frequency, Trends, and Outcomes of Cerebrovascular Events Associated With Atrial Fibrillation Hospitalizations

https://doi.org/10.1016/j.amjcard.2020.10.015Get rights and content

Highlights

  • Approximately 4.8% of atrial fibrillation hospitalizations were associated with cerebrovascular events. in this study

  • The trend of overall cerebrovascular events increased from 2005 to 2015, mainly contributed by the increased trends of acute ischemic stroke and acute hemorrhagic stroke.

  • The cerebrovascular events are associated with significantly higher resource utilization and cost of hospitalizations.

  • Hypertension, increasing age, chronic lung disease, chronic kidney disease and female gender were associated with cerebrovascular events in atrial fibrillation hospitalizations.

The main objective is to estimate the frequency, temporal trends, and outcomes of cerebrovascular events associated with atrial fibrillation (AF) hospitalization in the United States. The national inpatient sample data was utilized to identify hospitalizations with a primary or secondary diagnosis of AF from January 1, 2005 through September 31, 2015 for the present analysis. Jonckheere-Terpstra Trend was utilized to analyze trends from 2005 to 2015. Global Wald score was used to assess relative contributions of various covariates towards stroke among AF hospitalizations. Between the years 2005 and 2015, there were 36,457,323 (95.2%) AF hospitalizations without cerebrovascular events and 1,824,608 (4.8%) with cerebrovascular events included in the final analysis. There was a statistically significant increase in the proportion of overall stroke, AIS, and AHS (ptrend value <0.001) per 1,000 AF hospitalizations. The frequency of stroke per 1,000 AF hospitalizations was highest among patients with CHA2DS2VASc score ≥3 and Charlson's comorbidity index ≥3. The trend of in-hospital mortality decreased during the study period, however, it remained higher in those with cerebrovascular events compared to those without. Lastly, hypertension, advancing age, and chronic lung disease were major stroke predicting factors among AF hospitalizations. These cerebrovascular events were associated with longer length of stay and higher costs. In conclusion, the incidence of cerebrovascular events associated with AF hospitalizations remained significantly high and the trend continues to ascend despite technological advancements. Strategies should improve to reduce the risk of AF-related stroke in the United States.

Section snippets

Methods

The national inpatient sample (NIS) used for the present analysis is described earlier (URL: https://www.distributor.hcup-us.ahrq.gov/) (eMethod 1).3,7,8 This study was deemed exempt from Institutional Review Board approval due to the publicly available nature of the de-identified data. The NIS data pertaining to hospitalizations with AF as the primary or secondary diagnosis from January 1, 2005 through September 31, 2015 was utilized for the present analysis. The International Classification

Results

From 2005 to 2015, there were 36,457,323 (95.2%) AF hospitalizations without cerebrovascular events and 1,824,608 (4.8%) with cerebrovascular events (Table 1). Hospitalizations with cerebrovascular events had a higher mean age as compared to hospitalizations without cerebrovascular events (79 vs 76, p value <0.001). Additionally, AF hospitalizations with cerebrovascular events demonstrated a higher frequency of hospitalizations over 80 years of age compared to AF hospitalizations without

Discussion

In this largest study-to-date evaluating incidence of cerebrovascular stroke in AF hospitalizations, 4.8% of AF hospitalizations were associated with cerebrovascular events. The highest surge of AIS followed by AHS was observed. The trend of overall cerebrovascular events increased from 2005 to 2015, mainly contributed by the increased trends of AIS and AHS. The in-hospital mortality curtailed during the study period, however, it remained significantly higher in those with cerebrovascular

Authors’ Contributions

Rajkumar Doshi: Conceptualization, Methodology, Software, Formal analysis, Writing - Original Draft, Writing - Review & Editing, Supervision Devina Adalja: Conceptualization, Methodology, Writing - Original Draft, Writing - Review & Editing, Supervision Ashish Kumar: Conceptualization, Methodology, Software, Formal analysis, Writing - Original Draft, Writing - Review & Editing Mihir Dave: Conceptualization, Methodology, Software, Formal analysis, Writing - Original Draft, Writing - Review &

Disclosures

The authors have no conflicts of interest to disclose.

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    • Frequency, Trend, Predictors, and Impact of Gastrointestinal Bleeding in Atrial Fibrillation Hospitalizations

      2021, American Journal of Cardiology
      Citation Excerpt :

      The total cost of each hospital stay was analyzed by merging NIS data with cost-to-charge ratio files available from the sponsor. We estimated the final cost by adjusting the cost for inflation according to the Consumer Price Index data released by the United States Government.7 Multivariable logistic regression was used to adjust the outcomes for confounders.

    Funding: Dr. Saraschandra Vallabhajosyula is supported by the Clinical and Translational Science Award (CTSA) grant number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

    #

    Drs. Doshi and Adalja contributed equally in this manuscript as co-first authors.

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