Obesity paradox in atrial fibrillation and flutter: a multivariate nationwide inpatient analysis

Atrial Fibrillation and atrial flutter (Afib/Aflut) are the most common arrhythmias that present in the emergency department. This study aimed to evaluate in-hospital mortality based on weight categories in patients with Afib/flut. Using ICD-10 codes from the large Nationwide Inpatient Sample (NIS) database in the years 2016-2020, we evaluated any association between the presence of Afib/Aflut and mortality in different weight categories in adults over the age of 18. A total of 23,037,013 Afib/flut patients were found in the NIS database. Total mortality in patients with Afib/Aflut was 5.03%. Mortality in patients with normal weight was 5.26%. Mortality was lowest in overweight (2.3%) followed by Obesity (2.97%) and morbid obesity (2.97%). It was highest in cachectic patients (15.89%), all p-values were P<0.001. These associations persisted after multivariate adjustment for demographics and co-morbid conditions. Furthermore, Mortality was highest during the COVID-19 year of 2020, regardless of weight categories. The obesity paradox is present in patients admitted to the hospital with Afib/Aflut. Regardless of comorbid conditions or demographics, the lowest mortality was seen in overweight patients. Furthermore, the COVID-19 pandemic year independently increased inpatient mortality from Afib/Aflut.