What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=5528397). Intervention: Renal disease vs. Absence of renal disease. Primary outcome: In-hospital mortality (OR 3.98, 95% CI 3.85-4.11, p=<0.001).

What does this research mean for the field?

Renal disease is the strongest predictor of both 30-day readmission and in-hospital mortality following hospitalization for atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate national trends in primary atrial fibrillation hospitalizations, 30-day readmissions, and index in-hospital mortality in the United States from 2010 to 2022.

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August 14, 2026JACC AdvancesOpen Access

National Trends in Atrial Fibrillation Hospitalizations, Readmissions, and Mortality, 2010 to 2022

Q: What are the key findings of this study?

Renal disease was the strongest predictor of in-hospital mortality (OR 3.98) and 30-day readmission (OR 1.39) following primary atrial fibrillation hospitalization.

Q: What does this research mean for the field?

Renal disease is the strongest predictor of both 30-day readmission and in-hospital mortality following hospitalization for atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate national trends in primary atrial fibrillation hospitalizations, 30-day readmissions, and index in-hospital mortality in the United States from 2010 to 2022.

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Key result

Renal disease is linked to a ~4-fold increase in in-hospital mortality during AF hospitalizations.

OR 3.98
95% CI 3.85-4.11
P<0.001
n=5,528,397

Why the study?

Contemporary national data regarding AF hospitalization trends and risk factors predicting readmission and mortality are limited.

Key Points

To evaluate national trends in primary atrial fibrillation hospitalizations, 30-day readmissions, and index in-hospital mortality in the United States from 2010 to 2022.
Analyzed survey-weighted data from the Nationwide Readmissions Database between 2010 and 2022 covering 6,141,046 primary atrial fibrillation hospitalizations among 5,528,397 unique patients.
Identified risk factors for all-cause 30-day readmissions and index in-hospital mortality using cluster-adjusted multivariable logistic regression models.
Of 5,528,397 unique patients, 892,254 (16.1%) experienced 30-day readmission and 53,084 (0.96%) died during index admission, with total 2022 AF hospitalization costs reaching $7.2 billion.
Renal disease was the strongest predictor of both 30-day readmission (adjusted OR: 1.39; 95% CI: 1.37-1.40) and index in-hospital mortality (adjusted OR: 3.98; 95% CI: 3.85-4.11).
Increased odds of readmission and mortality were observed with Medicare (readmission OR: 1.46, 95% CI: 1.44-1.48; mortality OR: 1.17, 95% CI: 1.09-1.25), Medicaid (readmission OR: 1.62, 95% CI: 1.59-1.65; mortality OR: 1.43, 95% CI: 1.32-1.56), and heart failure (readmission OR: 1.38, 95% CI: 1.37-1.39; mortality OR: 1.83, 95% CI: 1.77-1.89).

Study Design

Type

Observational (n=5,528,397)

Multicenter

Yes

Structured PICO

Population

5,528,397 adult patients hospitalized with a primary diagnosis of atrial fibrillation in the United States between 2010 and 2022, assessed for 30-day readmission and in-hospital mortality.

Outcome

National trends in hospitalizations, 30-day readmissions, and in-hospital mortality during index admission for atrial fibrillationhard clinical

Main Result

Odds Ratio: 3.98 (95% CI 3.85–4.11)

p-value: p=<0.001

This nationwide analysis highlights a substantial burden of AF hospitalizations and readmissions, identifying renal disease, heart failure, COPD, and public insurance as key predictors of adverse short-term outcomes.

Limitations

Inability to track unique patients across different calendar years, preventing tracking of 30-day readmissions in December
Lack of granular clinical data such as vitals, laboratory values, and cardiac testing results
AF subtype analysis was not feasible across the full study period due to successive coding changes
Does not capture the postapproval era of pulsed field ablation
Did not employ a competing risks framework, classifying patients who died during index hospitalization as nonreadmitted
Lack of race and ethnicity data
Does not provide information regarding mortality that occurs outside of the hospital setting
Inability to track unique patients across different calendar years or readmissions in December
AF subtype analysis not feasible across the full study period due to successive coding changes
Does not capture the postapproval era of pulsed field ablation (post-2022)
Did not employ a competing risks framework for mortality and readmission
Lack of race/ethnicity data and out-of-hospital mortality data

Implication

Renal disease flags highest-risk AF hospitalizations for closer monitoring; hypothesis-generating for whether renal-focused strategies reduce mortality and readmissions.

Abstract

BACKGROUND Atrial fibrillation (AF) is a leading cause for acute cardiovascular hospitalizations. There is limited contemporary data about national trends and risk factors that predict readmission and mortality. OBJECTIVES The objective of the study was to identify national trends in hospitalizations, readmissions, and inpatient mortality during index admission for AF. METHODS Using nationally representative, survey-weighted hospitalization data, we assessed AF hospitalization trends and calculated risk factors for 30-day readmission and in-hospital mortality using cluster-adjusted multivariable logistic regression. RESULTS Between 2010 and 2022, there were 6,141,046 primary AF hospitalizations among 5,528,397 unique patients, of which 892,254 (16.1%) experienced 30-day readmission and 53,084 (0.96%) deaths during index admission. Renal disease was the strongest predictor of both 30-day readmission (adjusted OR: 1.39; 95% CI: 1.37-1.40) and in-hospital mortality (adjusted OR: 3.98; 95% CI: 3.85-4.11); public insurance was also strongly associated with adverse outcomes, including Medicare (readmission OR: 1.46; mortality OR: 1.17) and Medicaid coverage (readmission OR: 1.62; mortality OR: 1.43), along with lower income quartile, chronic obstructive pulmonary disease (readmission OR: 1.48; mortality OR: 1.66), heart failure (readmission OR: 1.38; mortality OR: 1.83), prior myocardial infarction (readmission OR: 1.26; mortality OR: 3.34), and female sex (readmission OR: 1.12; mortality OR: 1.07). Total cost of AF hospitalizations in 2022 was $7.2 billion. CONCLUSIONS In the United States, AF hospitalizations and readmissions experienced a modest overall net increase from 2010 to 2022, with a notable decline from 2014 to 2020 before rebounding following the COVID-19 pandemic, and 30-day readmissions and in-hospital mortality were associated with age, comorbidities, and socioeconomic factors.

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Cite This Study

Khan et al. (2026) conducted an observational in Atrial fibrillation (n=5,528,397). Renal disease vs. Absence of renal disease was evaluated on In-hospital mortality (OR 3.98, 95% CI 3.85-4.11, p=<0.001). Renal disease was the strongest predictor of in-hospital mortality (OR 3.98) and 30-day readmission (OR 1.39) following primary atrial fibrillation hospitalization.

synapsesocial.com/papers/6a7ee671b70b84ec8b914823 https://doi.org/10.1016/j.jacadv.2026.103118

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Implication

Renal disease flags highest-risk AF hospitalizations for closer monitoring; hypothesis-generating for whether renal-focused strategies reduce mortality and readmissions.