Key result
Hospitalization in patients with atrial fibrillation was associated with an increased risk of post-discharge death compared to no hospitalization (9.1% vs 2.2%; HR 3.6; 95% CI 3.2-4.0; P<0.0001).
Why the study?
Hospitalizations are common among patients with atrial fibrillation, but their causes and consequences during long-term anticoagulation therapy needed analysis.
Does hospitalization predict subsequent mortality in patients with atrial fibrillation treated with anticoagulation?
RCT (n=18,113)
Does hospitalization predict subsequent mortality in patients with atrial fibrillation treated with anticoagulation?
In patients with atrial fibrillation on anticoagulation, hospitalization is strongly associated with subsequent mortality, including vascular and sudden cardiac death.
Hospitalization signals higher post-discharge mortality risk in anticoagulated AF; hypothesis-generating and should not yet change practice.
AIMS: Hospitalizations are common among patients with atrial fibrillation. This article aimed to analyse the causes and consequences of hospitalizations occurring during the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial. METHODS AND RESULTS: The RE-LY database was used to evaluate predictors of hospitalization using multivariate regression modelling. The relationship between hospitalization and subsequent major adverse cardiac events was evaluated in a time dependent Cox proportional-hazard modelling. Of the 18 113 patients in RE-LY, 7200 (39.8%) were hospitalized at least once during a mean follow-up of 2 years. First hospitalization rates were 2312 (39.5%) for dabigatran etexilate (DE) 110, 2430 (41.6%) for DE 150, and 42.6% (N = 2458) for warfarin. Hospitalization was associated with post-discharge death [absolute event rate 9.1% vs. 2.2%; adjusted hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.2-4.0, P < 0.0001], vascular death (adjusted HR 2.9, 95% CI 2.5-3.3, P < 0.0001), and sudden cardiac death (adjusted HR 2.3; 95% CI 1.8-2.9, P < 0.0001). Cardiovascular hospitalization was also associated with an increased risk of post-discharge death (adjusted HR 2.8, 95% CI 2.5-3.2, P < 0.0001), vascular death (adjusted HR 2.8, 95% CI 2.4-3.2, P < 0.0001), and sudden cardiac death (adjusted HR 2.1, 95% CI 1.6-2.7, P < 0.0001) compared with patients not hospitalized for any cardiovascular reason. CONCLUSION: Hospitalizations are associated an increased risk of with death and cardiovascular death in patients with atrial fibrillation.
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Alak et al. (2019) conducted an RCT in atrial fibrillation (n=18,113). Hospitalization vs. No hospitalization was evaluated on post-discharge death (adjusted HR 3.6, 95% CI 3.2-4.0, p=< 0.0001). Hospitalization in patients with atrial fibrillation was associated with an increased risk of post-discharge death compared to no hospitalization (9.1% vs 2.2%; HR 3.6; 95% CI 3.2-4.0; P<0.0001).
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