Atrial flutter was independently associated with higher 30-day readmission in selected cancers (aOR 1.095; 95% CI 1.03-1.17; p=0.005), while atrial fibrillation readmission risk varied by cancer type.
Cohort (n=1,562,919)
Yes
Do specific cardiac arrhythmia phenotypes increase 30-day readmission and resource use in hospitalized adults with selected cancers?
In patients hospitalized with selected cancers, atrial flutter and certain cancer-specific atrial fibrillation phenotypes independently increase the risk of 30-day readmission and healthcare resource utilization.
Effect estimate: aOR 1.095 (95% CI 1.03-1.17)
p-value: p=0.005
11180 Background: Cardiac arrhythmias are common in oncology and may increase rehospitalization and resource use, but arrhythmia-type and cancer-specific readmission risk is incompletely characterized. Methods: Retrospective cohort of adult index hospitalizations for colorectal, breast, lung, prostate, kidney, or melanoma in the HCUP Nationwide Readmissions Database. Arrhythmias coded during the index stay (atrial fibrillation AF, atrial flutter AFL, ventricular tachycardia VT, supraventricular tachycardia SVT) were identified using ICD-10-CM codes. Primary outcome was all-cause 30-day readmission. For each phenotype, propensity-score matching (caliper 0. 05) created arrhythmia and no-arrhythmia cohorts balanced on demographics, payer, income quartile, and comorbidity. Multilevel logistic regression with hospital clustering estimated adjusted odds ratios (aOR) with 95% CI and tested arrhythmia-by-cancer interactions. Secondary outcomes were index length of stay (LOS) and total charges, analyzed with mixed-effects models; results are reported as adjusted mean differences (days) and incremental charges (USD). Two-sided p < 0. 05 was significant. Results: Among 1, 562, 919 index hospitalizations, AF was present in 214, 475 (13. 7%), AFL 27, 545 (1. 8%), VT 5, 184 (0. 3%), and SVT 25, 714 (1. 6%). After matching/adjustment, AFL was associated with higher 30-day readmission (aOR 1. 095, 95% CI 1. 03-1. 17; p = 0. 005). AF (aOR 1. 001, 0. 98-1. 03; p = 0. 940), VT (aOR 1. 128, 0. 99-1. 29; p = 0. 078), and SVT (aOR 1. 018, 0. 95-1. 09; p = 0. 598) were not significant overall. AF demonstrated cancer-specific heterogeneity: lung aOR 1. 092 (1. 043-1. 144; p < 0. 001) and melanoma aOR 1. 143 (1. 019-1. 283; p = 0. 023), while breast was not increased (aOR 0. 964, 0. 908-1. 025; p = 0. 242). In the AF model, older age was inversely associated with readmission (aOR 0. 974 per year, 95% CI 0. 972-0. 976; p < 0. 001). In the AF model, highest income quartile was associated with higher readmission (aOR 1. 409, 95% CI 1. 275-1. 557; p < 0. 001). AF/VT/SVT increased LOS: AF +0. 658 days, VT +1. 419 days, SVT +1. 146 days (p < = 0. 001) ; charges increased: AF +12, 399 (95% CI 8, 231-16, 569), VT +48, 114 (36, 846-59, 382), SVT +26, 656 (19, 822-33, 489) (all p < 0. 001). Conclusions: In selected cancers, AFL was independently associated with higher 30-day readmission, while AF readmission risk varied by cancer type. AF/VT/SVT were linked to increased LOS and charges, with the largest resource impact in VT. Prospective studies incorporating cancer stage and therapy exposures should test phenotype-guided cardio-oncology transitional care to reduce readmissions and costs. Limitations include ICD-coded phenotyping, inability to distinguish incident vs prevalent arrhythmias, and unavailable outpatient therapy/anticoagulation; residual confounding is possible. Misclassification may bias estimates toward null, particularly for VT.
Castillo et al. (Wed,) conducted a cohort in Colorectal, breast, lung, prostate, kidney, or melanoma cancers (n=1,562,919). Cardiac arrhythmias (AF, AFL, VT, SVT) vs. No arrhythmia was evaluated on All-cause 30-day readmission (aOR 1.095, 95% CI 1.03-1.17, p=0.005). Atrial flutter was independently associated with higher 30-day readmission in selected cancers (aOR 1.095; 95% CI 1.03-1.17; p=0.005), while atrial fibrillation readmission risk varied by cancer type.