Key result
Patients with atrial fibrillation treated in district hospitals had a significantly higher risk of major adverse events compared to those treated in academic hospitals (53% vs 37%, HR 1.24).
Why the study?
Atrial fibrillation is associated with increased hospitalization, but long-term outcomes comparing patients hospitalized in academic versus district hospitals remained to be evaluated.
Does treatment in a district hospital compared to an academic hospital affect long-term outcomes in patients with atrial fibrillation?
Cohort (n=2,983)
Yes
Does treatment in a district hospital compared to an academic hospital affect long-term outcomes in patients with atrial fibrillation?
Patients with atrial fibrillation treated at district hospitals have significantly worse long-term outcomes, including higher rates of mortality and thromboembolic events, compared to those treated at academic hospitals.
AF patients at district hospitals had worse outcomes; leaves open whether hospital type or unmeasured factors drive differences.
Introduction: Atrial fibrillation (AF) is associated with increased hospitalization. Objectives: We aimed to compare long-term outcomes in patients with AF hospitalized in academic and district hospitals. Patients and methods: This retrospective observational study included data from the Multicenter Experience in Atrial Fibrillation Patients Treated with Oral Anticoagulants (CRAFT; NCT02987062) study which included AF patients hospitalized between 2011 and 2016 in academic and district hospitals. The primary end point was a major adverse event (MAE) defined as all-cause death and thromboembolic and hemorrhagic events during the median 4-year follow-up. Results: We analyzed 2983 patients with AF: 2271 (76%) from academic and 712 (24%) from district hospitals. Patients treated in district hospitals, as compared with patients treated in academic hospitals, more often experienced MAEs (53% vs 37%; P <0.001), all-cause death (40% vs 24%; P <0.001), and thromboembolic events (13% vs 7.8%; P <0.001), with similar rates of hemorrhagic events (15% vs 15%; P = 1.00). In multivariable logistic regression, female sex, coronary artery disease, smoking, and antiplatelet drug therapy were associated with greater likelihood of thromboembolic events in academic hospitals. Heart failure, renal failure, and vitamin K antagonist (in academic hospitals), and coronary artery disease (in district hospitals) were associated with greater likelihood of hemorrhagic events. District (vs academic) conditions were associated with higher risk of MAEs and all-cause death in men and those with low risk of bleeding, and with higher incidence of thromboembolic events in women, elderly patients, and those with high risk of bleeding and with diabetes. Conclusions: Patients with AF treated at district hospitals had worse long-term outcomes than those treated in academic conditions.
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Lodziński et al. (2021) conducted a cohort in Atrial fibrillation (n=2,983). Treatment in a district hospital vs. Treatment in an academic hospital was evaluated on Major adverse event (MAE) defined as all-cause death, thromboembolic, and hemorrhagic events (HR 1.24, 95% CI 1.07-1.44, p=<0.01). Patients with atrial fibrillation treated in district hospitals had a significantly higher risk of major adverse events compared to those treated in academic hospitals (53% vs 37%, HR 1.24).
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