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

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

doi:10.1016/j.mayocpiqo.2023.04.008

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

Mayo Clin Proc Innov Qual Outcomes. 2023 Jun 2;7(4):222-230. doi: 10.1016/j.mayocpiqo.2023.04.008. eCollection 2023 Aug.

Affiliations

¹ Department of Internal Medicine, Louisiana State University Health, Shreveport.
² Department of Neurology, Louisiana State University Health, Shreveport.
³ Department of Cardiology, Houston Methodist Hospital, Houston, TX.
⁴ Division of Cardiology, Southern Illinois University, Springfield, IL.
⁵ Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL.
⁶ Department of Neurology, Mayo Clinic, Rochester, MN.
⁷ Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.
⁸ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.

Abstract

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.