Effects of Non-Alcoholic Fatty Liver Disease on the Inpatient Outcomes of Patients Admitted for Atrial Fibrillation: An Analysis from the National Inpatient Sample Database (NIS 2016–2019)

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Fibrillation (n=1891479). Intervention: Concurrent Non-alcoholic fatty liver disease (NAFLD) vs. Patients without concurrent NAFLD. Primary outcome: Inpatient all-cause mortality (aOR 0.89, 95% CI 0.57-1.39, p=0.608).

Q: What does this research mean for the field?

Concurrent non-alcoholic fatty liver disease (NAFLD) in patients hospitalized for atrial fibrillation is associated with longer hospital stays and higher costs, but does not significantly affect inpatient mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Xiuhong Lyu; Bolun Liu; Yiting Li

doi:10.3390/jcdd13090436

September 4, 2026Journal of Cardiovascular Development and DiseaseOpen Access

Effects of Non-Alcoholic Fatty Liver Disease on the Inpatient Outcomes of Patients Admitted for Atrial Fibrillation: An Analysis from the National Inpatient Sample Database (NIS 2016–2019)

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Key result

Concurrent non-alcoholic fatty liver disease in patients hospitalized for atrial fibrillation did not significantly affect inpatient all-cause mortality (aOR 0.89, 95% CI 0.57-1.39, p=0.608).

Why the study?

Emerging evidence links NAFLD to an increased risk of AF, but data regarding the impact of NAFLD on inpatient outcomes among patients admitted for AF remain limited.

Does concurrent NAFLD impact inpatient mortality, length of stay, and hospital costs in patients admitted for atrial fibrillation?

Key Points

To assess the impact of concurrent non-alcoholic fatty liver disease (NAFLD) on inpatient outcomes, mortality, and healthcare resource utilization among patients hospitalized with atrial fibrillation.
Retrospective analysis of the National Inpatient Sample (NIS 2016–2019) identifying adult hospitalizations with a primary discharge diagnosis of atrial fibrillation (ICD-10: I48.x) with and without concurrent NAFLD (weighted N=1,891,479).
Multivariable linear and logistic regression models adjusted for age, sex, race, insurance status, and Charlson Comorbidity Index to evaluate in-hospital mortality, length of stay, costs, and complications.
Concurrent NAFLD was associated with a significantly longer hospital length of stay (3.99 vs. 3.35 days, p < 0.001) and higher mean hospital costs ($13,841.65 vs. $12,154.55, p = 0.046).
Inpatient all-cause mortality did not differ significantly between patients with and without NAFLD (0.72% vs. 0.85%; unadjusted OR = 0.85, 95% CI 0.55–1.33; adjusted OR = 0.89, 95% CI 0.57–1.39, p = 0.608).
Patients with NAFLD had lower adjusted odds of undergoing catheter ablation (aOR = 0.67, 95% CI 0.57–0.79, p < 0.001), developing acute myocardial infarction (aOR = 0.61, 95% CI 0.48–0.77, p < 0.001), and requiring hemodialysis (aOR = 0.38, 95% CI 0.27–0.53, p < 0.001).

Study Design

Type

Observational (n=1,891,479)

Multicenter

Yes

Structured PICO

Does concurrent NAFLD impact inpatient mortality, length of stay, and hospital costs in patients admitted for atrial fibrillation?

P

Population

1,891,479 adult hospitalizations in the United States with a primary diagnosis of atrial fibrillation, comparing inpatient outcomes between those with and without concurrent non-alcoholic fatty liver disease.

E

Exposure

Concurrent diagnosis of Non-alcoholic fatty liver disease (NAFLD) / Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

C

Comparator

Patients admitted for atrial fibrillation without concurrent NAFLD

O

Outcome

Inpatient all-cause mortalityhard clinical

Main Result

Odds Ratio: 0.89 (95% CI 0.57–1.39)

Absolute Event Rate: 0.72% vs 0.85%

p-value: p=0.608

Concurrent NAFLD in patients hospitalized for atrial fibrillation is associated with significantly increased healthcare resource utilization, including longer length of stay and higher costs, without a significant difference in inpatient mortality.

Limitations

Susceptible to errors related to coding inaccuracies inherent to administrative databases.
Did not capture patients admitted for other primary diagnoses who were later found to have atrial fibrillation.
Unable to differentiate between new-onset and chronic persistent atrial fibrillation due to non-specific ICD-10 coding.
Retrospective observational design precludes establishing causality.
Limited to inpatient outcomes without long-term follow-up data.
Inflammatory status and subclinical markers (e.g., IL-6, TNF-alpha, CRP) could not be directly evaluated.
Susceptible to errors related to coding inaccuracies in administrative databases
May underestimate AF hospitalization frequency if AF was coded as a secondary diagnosis (e.g., admitted for syncope)
Unable to distinguish between new-onset atrial fibrillation and chronic persistent atrial fibrillation
Retrospective observational design cannot establish causality
Only focused on inpatient outcomes without long-term follow-up data
Inflammatory markers (IL-6, TNF-alpha, CRP) were not directly evaluated

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Implication

Concurrent NAFLD was not linked to higher inpatient mortality in AF admissions but was associated with longer stays and costs; leaves open effects on longer-term outcomes.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD), which is recognized under the updated nomenclature as Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), is increasingly prevalent in the United States and worldwide. Emerging evidence links NAFLD to an elevated risk of atrial fibrillation (AF), yet data regarding the impact of NAFLD on inpatient outcomes among patients admitted for AF remain limited. Methods: The National Inpatient Sample (NIS) from 2016 to 2019 was used to identify adult patients with a primary discharge diagnosis of AF (ICD-10: I48.x). Patients with concurrent NAFLD were compared to those without. Multivariable linear and logistic regression analyses were performed, adjusting for age, sex, race, insurance status, and Charlson Comorbidity Index. The primary outcome was inpatient all-cause mortality. Secondary outcomes included length of stay, inflation-adjusted hospital costs, discharge disposition, and in-hospital complications. Results: Of 1,891,479 weighted AF admissions, 13,840 carried a concurrent NAFLD diagnosis. Concurrent NAFLD was associated with longer length of stay (3.99 vs. 3.35 days, p < 0.001) (which is statistically significant though might be clinically insignificant) and higher hospital costs ($13,841.65 vs. $12,154.55, p = 0.046). No significant difference in inpatient mortality was observed. Conclusions: Concurrent NAFLD among AF hospitalizations is associated with greater resource utilization without a significant mortality difference, highlighting the importance of addressing this comorbidity to reduce the economic burden of AF-related hospitalizations.

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Cite This Study

Lyu et al. (2026) conducted an observational in Atrial Fibrillation (n=1,891,479). Concurrent Non-alcoholic fatty liver disease (NAFLD) vs. Patients without concurrent NAFLD was evaluated on Inpatient all-cause mortality (aOR 0.89, 95% CI 0.57-1.39, p=0.608). Concurrent non-alcoholic fatty liver disease in patients hospitalized for atrial fibrillation did not significantly affect inpatient all-cause mortality (aOR 0.89, 95% CI 0.57-1.39, p=0.608).

synapsesocial.com/papers/6a9d1e9328139818eab218bc https://doi.org/10.3390/jcdd13090436

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Effects of Non-Alcoholic Fatty Liver Disease on the Inpatient Outcomes of Patients Admitted for Atrial Fibrillation: An Analysis from the National Inpatient Sample Database (NIS 2016–2019)

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Effects of Non-Alcoholic Fatty Liver Disease on the Inpatient Outcomes of Patients Admitted for Atrial Fibrillation: An Analysis from the National Inpatient Sample Database (NIS 2016–2019)

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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