Incidence of All-Cause, Cardiovascular, and Atrial Fibrillation-Related Hospitalizations

Danilo Menichelli, MD; Pasquale Pignatelli, MD, PhD; Tommaso Brogi, MD; Arianna Pannunzio, MD; Francesco Violi, MD; Gregory Y.H. Lip, MD; Daniele Pastori, MD; Tiziana Di Stefano; Elio Sabbatini; Patrizia Iannucci; Alberto Befani; Ilaria Maria Palumbo; Emanuele Valeriani

JACC: Advances (Aug 2024)

Incidence of All-Cause, Cardiovascular, and Atrial Fibrillation-Related Hospitalizations

Danilo Menichelli, MD,
Pasquale Pignatelli, MD, PhD,
Tommaso Brogi, MD,
Arianna Pannunzio, MD,
Francesco Violi, MD,
Gregory Y.H. Lip, MD,
Daniele Pastori, MD,
Tiziana Di Stefano,
Elio Sabbatini,
Patrizia Iannucci,
Alberto Befani,
Ilaria Maria Palumbo,
Emanuele Valeriani

Affiliations

Danilo Menichelli, MD: Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy
Pasquale Pignatelli, MD, PhD: Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
Tommaso Brogi, MD: Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
Arianna Pannunzio, MD: Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
Francesco Violi, MD: Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
Gregory Y.H. Lip, MD: Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Daniele Pastori, MD: Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Address for correspondence: Dr Daniele Pastori, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy.
Tiziana Di Stefano
Elio Sabbatini
Patrizia Iannucci
Alberto Befani
Ilaria Maria Palumbo
Emanuele Valeriani

Journal volume & issue: Vol. 3, no. 8
p. 101117

Abstract

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Background: Atrial fibrillation (AF) is associated with an increased risk of hospital admission, but few data on reasons for hospitalization and on the role of anti-arrhythmic drugs are available. Objectives: The purpose of this study was to investigate the incidence rate and factors associated with all-cause, cardiovascular, and AF-related hospitalizations. Methods: Prospective ongoing ATHERO-AF (Atherosclerosis in Atrial Fibrillation) cohort study enrolling AF patients on oral anticoagulants. Primary end points were all-cause, cardiovascular, and AF-related hospitalization, the latter defined as AF recurrences for paroxysmal AF and high-rate symptomatic AF episodes for persistent/permanent AF patients. Results: 2,782 patients were included (43.5% female; mean age was 74.6 ± 9.1 years). During a mean follow-up of 31 ± 26.8 months, 1,205 (12.1%/year) all-cause, 533 cardiac (5.7%/year), and 180 (2.0%/year) AF-related hospitalizations occurred. Predictors of AF-related hospitalizations were the use of flecainide/propafenone in both paroxysmal and persistent/permanent AF patients (HR: 1.861; 95% CI: 1.116 to 3.101 and 1.947; 95% CI: 1.069 to 3.548, respectively). Amiodarone (HR: 3.012; 95% CI: 1.835-4.943), verapamil/diltiazem (HR: 2.067; 95% CI: 1.117-3.825), and cancer (HR: 1.802; 95% CI: 1.057-3.070) but not beta-blockers and digoxin were associated with an increased risk of AF-related hospitalizations in persistent/permanent AF patients. Conclusions: Elderly AF patients frequently undergo hospitalizations for both cardiovascular and noncardiovascular causes. The use of anti-arrhythmic drugs was associated with an increased risk of AF-related hospitalization suggesting a scarce effect of these drugs in preventing AF episodes. Therefore, their use should be carefully considered and reserved for symptomatic patients with frequent AF recurrences.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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