Key result
Bariatric surgery in obese patients with atrial fibrillation was associated with lower 1-year all-cause mortality (2.18% vs 2.73%; HR 0.91; 95% CI 0.85-0.96; p=0.001).
Why the study?
Obesity is linked to an increased burden of AF and related complications, prompting evaluation of whether bariatric surgery reduces 1-year mortality and long-term complications in AF patients.
Does bariatric surgery reduce mortality and complications at 1 year in obese patients with atrial fibrillation?
Cohort (n=892,488)
Yes
Does bariatric surgery reduce mortality and complications at 1 year in obese patients with atrial fibrillation?
Hazard Ratio: 0.91 (95% CI 0.85–0.96)
Absolute Event Rate: 2.18% vs 2.73%
p-value: p=0.001
In obese patients with atrial fibrillation, bariatric surgery is associated with reduced 1-year mortality and ischemic stroke, but an increased risk of major bleeding.
Introduction: Obesity is associated with a higher burden of atrial fibrillation (AF) and related complications. Hypothesis: Bariatric surgery in patients with AF is associated with a reduction in mortality and long-term complications at 1 year. Methods: Patients with AF who underwent bariatric surgery were identified by analyzing the nationwide readmission database and incorporating the validated ICD-10 CM codes from October 2015 to December 2019. We performed the propensity score matching to adjust the confounders and cox proportional hazard regression to generate hazard ratios. Moreover, we generated Kaplan Meier curves for time-to-event analysis. The primary endpoint was all-cause mortality at 1 year, whereas secondary endpoints were ischemic stroke, major bleeding, and AF readmission at 1 year. Results: Out of 892488 obese patients with AF, 18766 underwent bariatric surgery. After propensity score matching, 18764 patients were identified in each group. At 1-year, patients undergoing bariatric surgery had a significant reduction in mortality (2.18% vs. 2.73%, HR: 0.91, 95% CI: 0.85-0.96, p=0.001). Additionally, risk of ischemic stroke was also reduced (1.98% vs. 2.29%, HR: 0.91, 95% CI: 0.86-0.97, p=0.01), whereas no difference was noted in AF readmissions (4.02% vs. 3.34%, HR: 0.97, 95% CI: 0.92-1.04, p=0.49) and risk of major bleeding was increased (5.74% vs. 3.42%, HR: 1.17, 95% CI: 1.10-1.25, p<0.0001) at 1 year in AF patients with bariatric surgery. (Figure 1) Conclusions: Bariatric surgery in patients with AF was associated with a reduction in 1-year mortality and ischemic stroke. However, the risk of major bleeding was noted to be increased and no difference was noted in AF readmission at 1 year.
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Thakkar et al. (2022) conducted a cohort in Atrial fibrillation and obesity (n=892,488). Bariatric surgery vs. No bariatric surgery was evaluated on all-cause mortality at 1 year (HR 0.91, 95% CI 0.85-0.96, p=0.001). Bariatric surgery in obese patients with atrial fibrillation was associated with lower 1-year all-cause mortality (2.18% vs 2.73%; HR 0.91; 95% CI 0.85-0.96; p=0.001).
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