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May 20, 2021Journal of the American Heart AssociationOpen Access

National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure

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Key result

Comorbid AF during HF hospitalizations is linked to ~38% higher in-hospital mortality.

  • P<0.001
  • n=10,392,189

Why the study?

Heart failure and atrial fibrillation frequently coexist and may worsen outcomes, but limited contemporary evidence describes their combined prevalence across HFpEF and HFrEF hospitalizations in the United States.

What are the national trends in the prevalence, outcomes, and costs of atrial fibrillation during hospital admissions for heart failure?

Population

10 392 189 hospitalizations for HF in the United States between 2008 and 2017

Comparison

Comorbid AF vs without AF in HF hospitalizations

Design

Retrospective database study using the National Inpatient Sample

Authors

SRSamuel W. ReinhardtFCFouad ChouairiPMP. Elliott Miller

Discussion

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Overview

Comorbid AF flags higher mortality risk in HF admissions; leaves open whether targeted interventions improve outcomes.

Key Points

  • To examine trends in the prevalence of atrial fibrillation among hospitalizations for heart failure in the U.S. from 2008 to 2017.
  • Analyzed 10,392,189 hospitalizations for heart failure using the National Inpatient Sample between 2008 and 2017.
  • Identified 4,250,698 cases with comorbid atrial fibrillation (40.9%).
  • Assessed demographic changes and hospital outcomes, including mortality and costs.
  • The proportion of comorbid atrial fibrillation rose from 35.4% in 2008 to 45.4% in 2017.
  • In-hospital mortality was higher in patients with atrial fibrillation at 3.6%, compared to 2.6% without it.
  • Hospital charges increased by 40% for heart failure admissions with atrial fibrillation, from $22,204 to $31,145.

Study Design

Type

Observational (n=10,392,189)

Multicenter

Yes

Structured PICO

What are the national trends in the prevalence, outcomes, and costs of atrial fibrillation during hospital admissions for heart failure?

P
Population
10,392,189 hospitalizations for heart failure (HFpEF or HFrEF) in the United States between 2008 and 2017
C
Comparator
Heart failure hospitalizations without atrial fibrillation
O
Outcome
Trends in comorbid atrial fibrillation prevalence, in-hospital mortality, and hospital costshard clinical

Main Result

Absolute Event Rate: 3.6% vs 2.6%

p-value: p=<0.001

Atrial fibrillation is increasingly common among heart failure hospitalizations and is associated with higher in-hospital mortality and costs.

Cite This Study

Reinhardt et al. (2021) conducted an observational in Heart failure (n=10,392,189). Comorbid atrial fibrillation vs. No atrial fibrillation was evaluated on In-hospital mortality (p=<0.001). Comorbid atrial fibrillation during heart failure hospitalizations was associated with higher in-hospital mortality compared to those without atrial fibrillation (3.6% vs 2.6%; P<0.001).

synapsesocial.com/papers/6a08aba67de338f10b10e754https://doi.org/10.1161/jaha.120.019412
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Newly Diagnosed Atrial Fibrillation and Hospital Utilization in Heart Failure: A Nationwide Cohort Study2021 · 5 citations
  2. 2Long-term Healthcare Utilization and Outcomes in Patients Hospitalized for Heart Failure with and without Atrial Fibrillation2025
  3. 3Heart Failure in Patients With Atrial Fibrillation Is Associated With a High Symptom and Hospitalization Burden: The RealiseAF Survey2013 · 28 citations
  4. 4Clinical characteristics and in-hospital outcomes of acute decompensated heart failure patients with and without atrial fibrillation2020 · 11 citations
  5. 5Intersection of Atrial Fibrillation and Heart Failure with Mildly Reduced and Preserved Ejection Fraction in &amp;gt;400 000 Participants in the Get With The Guidelines-Heart Failure Registry2022 · 27 citations