Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Aug 2023)

Impact of Atrial Fibrillation on Outcomes in Patients Hospitalized With Nontraumatic Intracerebral Hemorrhage

  • Sahith Reddy Thotamgari, MD,
  • Akhilesh Babbili, MD,
  • Prabandh Bucchanolla, MD,
  • Samarthkumar Thakkar, MD,
  • Harsh P. Patel, MD,
  • Maja B. Spaseski, MD,
  • Jonathan Graff-Radford, MD,
  • Alejandro A. Rabinstein, MD,
  • Zain Ul Abideen Asad, MD, MS,
  • Samuel J. Asirvatham, MD,
  • David R. Holmes, Jr., MD,
  • Abhishek Deshmukh, MD,
  • Christopher V. DeSimone, MD, PhD

Journal volume & issue
Vol. 7, no. 4
pp. 222 – 230

Abstract

Read online

Objective: To assess the effect of atrial fibrillation (AF) on outcomes in hospitalizations for non-traumatic intracerebral hemorrhage (ICH). Patients and Methods: We queried the National Inpatient Sample database between January 1, 2016, and December 31, 2019, to identify hospitalizations with an index diagnosis of non-traumatic ICH using ICD-10 code I61. The cohort was divided into patients with and without AF. Propensity score matching was used to balance the covariates between AF and non-AF groups. Logistic regression was used to analyze the association. All statistical analyses were performed using weighted values. Results: Our cohort included 292,725 hospitalizations with a primary discharge diagnosis of non-traumatic ICH. From this group, 59,005 (20%) recorded a concurrent diagnosis of AF, and 46% of these patients with AF were taking anticoagulants. Patients with AF reported a higher Elixhauser comorbidity index (19.8±6.0 vs 16.6±6.4; P<.001) before propensity matching. After propensity matching, the multivariate analysis reported that AF (aOR, 2.34; 95% CI, 2.26-2.42; P<.001) and anticoagulation drug use (aOR, 1.32; 95% CI, 1.28-1.37; P<.001) were independently associated with all-cause in-hospital mortality. Moreover, AF was significantly associated with respiratory failure requiring mechanical ventilation (odds ratio, 1.57; 95% CI, 1.52-1.62; P<.001) and acute heart failure (odds ratio, 1.26; 95% CI, 1.19-1.33; P<.001) compared with the absence of AF. Conclusion: These data suggest that non-traumatic ICH hospitalizations with coexistent AF are associated with worse in-hospital outcomes such as higher mortality and acute heart failure.