Atrial fibrillation during cancer hospitalizations was independently associated with increased in-hospital mortality (OR 1.75; 95% CI 1.70-1.80) and higher illness severity compared to no AF.
Cross-Sectional (n=961,848)
Yes
Does the presence of atrial fibrillation increase inpatient severity, critical care utilization, and mortality in adult hospitalizations with a principal diagnosis of malignancy?
Atrial fibrillation during cancer hospitalizations is an independent predictor of higher illness severity, ICU-level care utilization, and in-hospital mortality.
Effect estimate: OR 1.75 (95% CI 1.70-1.80)
Absolute Event Rate: 7.75% vs 3.93%
e23098 Background: Atrial fibrillation (AF) is highly prevalent among patients with cancer and is frequently treated as a chronic comorbidity during hospitalization. Whether the presence of AF during cancer hospitalizations independently amplifies acute inpatient severity, critical care utilization, and mortality at a national level remains incompletely defined. Methods: A serial cross-sectional analysis was performed using adult hospitalizations with a principal diagnosis of malignancy in the 2018–2022 Healthcare Cost and Utilization Project National Inpatient Sample. AF/atrial flutter was identified using any-diagnosis ICD-10-CM code I48*. Outcomes included All Patient Refined Diagnosis Related Group (APR-DRG) severity of illness, extreme severity (APR-DRG level 4), in-hospital mortality, shock (R57*), mechanical ventilation, length of stay (LOS), and hospitalization cost. National estimates accounted for survey stratification, clustering, and discharge-level weighting. Survey-weighted multivariable regression adjusted for demographics, payer, ZIP-code income quartile, admission characteristics, cancer type, hospital characteristics, and year. Results: Among 961, 848 unweighted cancer hospitalizations, representing 4, 809, 239 admissions nationally, AF was present in 11. 9%. Hospitalizations with AF demonstrated substantially higher acuity compared with those without AF. Mean APR-DRG severity was higher (2. 99 vs 2. 50), and extreme severity occurred more frequently (5. 19% vs 3. 22%). In-hospital mortality was nearly doubled among AF-associated admissions (7. 75% vs 3. 93%). AF was also associated with higher rates of shock (2. 83% vs 1. 19%) and mechanical ventilation (4. 97% vs 2. 26%), longer LOS (8. 23 vs 6. 44 days), and greater hospitalization costs (26, 265 vs 22, 365). After multivariable adjustment, AF remained independently associated with increased inpatient severity (APR-DRG severity β 0. 38, 95% CI 0. 36–0. 39), extreme severity (odds ratio OR 1. 79, 95% CI 1. 72–1. 86), in-hospital mortality (OR 1. 75, 95% CI 1. 70–1. 80), shock (OR 2. 34, 95% CI 2. 23–2. 44), and mechanical ventilation (OR 2. 36, 95% CI 2. 28–2. 44). Conclusions: Atrial fibrillation occurring during cancer-related hospitalizations functions as an acute inpatient severity amplifier. The presence of AF as a comorbidity was independently associated with higher illness severity, ICU-level care, and mortality. These findings support reframing and prioritizing AF as a clinically actionable marker of inpatient decompensation rather than a chronic comorbidity, with implications for early risk stratification and escalation strategies in hospitalized oncology populations.
Aboujaoude et al. (Thu,) conducted a cross-sectional in Cancer hospitalizations (n=961,848). Atrial fibrillation vs. No atrial fibrillation was evaluated on In-hospital mortality (OR 1.75, 95% CI 1.70-1.80). Atrial fibrillation during cancer hospitalizations was independently associated with increased in-hospital mortality (OR 1.75; 95% CI 1.70-1.80) and higher illness severity compared to no AF.