Abstract 10215: Predictors of Cause-Specific Hospitalization in US Outpatients With Atrial Fibrillation: Results From the ORBIT-AF Study
Background: Atrial fibrillation (AF) is common and costly. We sought to assess the burden and factors associated with hospitalization in patients with AF.
Methods: The ORBIT-AF registry enrolled outpatients with AF from diverse practice settings and collected detailed data on cause-specific hospitalization. The present analysis describes the incidence of hospitalization in patients with AF.
Results: Of 9,484 patients in ORBIT-AF with follow-up at 1 year, 21% (n=1980) had 1 hospitalization and 10% (n=983) had >1 hospitalization. First all-cause hospitalization occurred at a rate of 38 per 100 patient-years, most for cardiovascular reasons (20 per 100 pt-years vs. 3.2 bleeding and 17 other). Compared with those who were not hospitalized, patients with 1 hospitalization were slightly older (median age 76 vs. 75, p=0.0002), and more likely to have CAD (37% vs. 29%, p<0.0001) and heart failure (39% vs. 28%, p<0.0001). Gender (43% vs. 42% female, p=0.08) and type of AF (49% vs. 51% paroxysmal, p=0.5) were not significantly different (Figure). Use of antiarrhythmics (30% for 1 hospitalization vs. 28% for none, p=0.005) and warfarin (73% vs. 71%, p=0.3) were minimally different. Patients on warfarin who were hospitalized had lower time in therapeutic range compared with those not hospitalized (56% vs. 65%, p<0.0001). In multivariable analyses, heart failure status was a major predictor of first all-cause (adjusted HR 1.51 for NYHA class III/IV vs. none, p<0.0001) and cardiovascular hospitalization (adjusted HR 1.67, p<0.0001). Patients with EHRA severe symptoms (adjusted HR 1.8 vs. no symptoms, p<0.0001) also had a significantly increased risk of cardiovascular hospitalization.
Conclusions: Hospitalization is common in patients with AF, and many experience >1 hospitalizations annually. These are most frequently cardiovascular hospitalizations and are associated with concomitant heart failure, lower quality anticoagulation, and more severe symptoms.
- © 2013 by American Heart Association, Inc.