Elsevier

The American Journal of Cardiology

Volume 143, 15 March 2021, Pages 125-130
The American Journal of Cardiology

Impact of Arrhythmias on Hospitalizations in Patients With Cardiac Amyloidosis

https://doi.org/10.1016/j.amjcard.2020.12.024Get rights and content

Cardiac involvement in amyloidosis is associated with a poor prognosis. Data on the burden of arrhythmias in patients with cardiac amyloidosis (CA) during hospitalization are lacking. We identified the burden of arrhythmias using the National Inpatient Sample (NIS) database from January 2016 to December 2017. We compared patient characteristics, outcomes, and hospitalization costs between CA patients with and without documented arrhythmias. Out of 5,585 hospital admissions for CA, 2,020 (36.1%) had concurrent arrhythmias. Propensity-score matching for age, sex, income, and co-morbidities was performed with 1,405 CA patients with arrhythmias and 1,405 patients without. The primary outcome of all-cause mortality was significantly higher in CA patients with arrhythmia than without(13.9% vs 5.3%, p-value <0.001). Atrial fibrillation (AF) was the most common (72.2%) arrhythmia in CA patients with concurrent arrhythmia. The secondary outcomes of AF-related mortality (11.95% vs 9.16%, p-value = 0.02) and acute and acute on chronic as heart failure (HF) exacerbation (32.38% vs 24.91%, p-value <0.0001) were significantly higher in CA and concurrent arrhythmia compared with CA patients without. The total length of hospital stay (6[3 to 12] vs 5[3 to 10], p-value <0.001) and cost of hospitalization were ($ 15,086[7,813 to 30,373] vs $ 12,219[6,865 to 23,997], p-value = 0.001) were significantly greater among CA with arrhythmia compared with those without. These data suggest that the presence of arrhythmias in CA patients during hospital admission is associated with a poorer prognosis and may reflect patients with a higher risk of HF exacerbation and mortality.

Section snippets

Methods

A population-based sample of 5,585 CA related hospitalizations in patients aged >18 with or without arrhythmias was analyzed in a retrospective manner from 2016 to 2017 using the National inpatient sample (NIS) database (Figure 1). The NIS is the largest publicly available all-payer inpatient care database in the United States. Weighted, it estimates data on more than 35 million hospital stays nationally. It was set in motion by the Healthcare Cost and Utilization Project (HCUP) through a

Results

A total of 5,585 hospital admissions with CA were included in the analysis (Figure 1). Among this cohort, 2,020 (36.1%) had concurrent arrhythmia compared with 3,565 (63.8%), who had no concurrent arrhythmias. CA hospitalizations were more common in older patients(>75 years, 54.5% in CA with arrhythmia and 41.6% CA without arrhythmia, p <0.0001), Caucasians (65.2% in CA with arrhythmia and 64.3% CA without arrhythmia, p <0.0001), and those on Medicare (77.2% vs 70.1%, p <0.0001). Similar

Discussion

Our analysis of 5,585 hospitalizations with CA revealed the following findings; (1) Arrhythmias in patients with CA hospitalizations were associated with increased in-hospital mortality, acute heart failure exacerbations, increased length of stay, and hospitalization costs; (2) AF was identified as the most frequent arrhythmia among hospitalizations with CA.

An increased prevalence of AF among patients with CA echoes trends observed in previous observational studies, particularly among elderly

Credit Author Statement

Thakkar: Conceptualization; Methodology; Visualization; Writing- Original draft preparation. Patel: Conceptualization; Methodology; Software; Writing- Original draft preparation. Chowdhury: Conceptualization; Methodology; Writing- Original draft preparation. Patel: Methodology; Software. Kumar: Methodology; Software; Validation; Writing- Reviewing and Editing. Arora: Conceptualization; Methodology. Zahid: Conceptualization. Goel: Conceptualization. Barssoum: Conceptualization. Jain:

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (24)

  • K Sanchis et al.

    Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis: clinical and echocardiographic features, impact on mortality

    Amyloid

    (2019)
  • C Röcken et al.

    Atrial amyloidosis: an arrhythmogenic substrate for persistent atrial fibrillation

    Circulation

    (2002)
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    Funding Source: None.

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    Thakkar and Patel contributed equally to this manuscript as co-first authors.

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