What is the clinical evidence from this study?

Study design: Observational. Population: Haematopoietic stem cell transplantation (HSCT) (n=50570). Intervention: Atrial fibrillation vs. Without atrial fibrillation. Primary outcome: Inpatient mortality (aOR 2.75, 95% CI 1.9-3.98, p=< 0.001).

May 1, 2023Open Access

Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation

Q: What are the key findings of this study?

In patients aged >50 years undergoing haematopoietic stem cell transplantation, atrial fibrillation was independently associated with higher inpatient mortality (aOR 2.75; 95% CI 1.9-3.98; P<0.001).

Key Result

In patients aged >50 years undergoing haematopoietic stem cell transplantation, atrial fibrillation was independently associated with higher inpatient mortality (aOR 2.75; 95% CI 1.9-3.98; P<0.001).

Study Design

Type

Observational (n=50,570)

Multicenter

Yes

Structured PICO

Is atrial fibrillation associated with worse in-hospital outcomes in patients aged >50 years undergoing haematopoietic stem cell transplantation?

Population

50,570 weighted hospitalizations of patients aged >50 years undergoing haematopoietic stem cell transplantation (HSCT) from the National Inpatient Sample (2016-2019).

Intervention

Diagnosis of atrial fibrillation (AF)

Comparator

No diagnosis of atrial fibrillation

Outcome

Inpatient mortalityhard clinical

In patients over 50 undergoing haematopoietic stem cell transplantation, the presence of atrial fibrillation is independently associated with significantly worse in-hospital outcomes, including higher mortality, longer length of stay, and increased costs.

Main Result

Effect estimate: aOR 2.75 (95% CI 1.9-3.98)

p-value: p=< 0.001

Abstract

AIMS: Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. METHODS AND RESULTS: The National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001). CONCLUSION: Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.