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Racial Differences in Hospital Death for Atrial Fibrillation: The National Inpatient Sample 2001-2012.

ABSTRACT: Background:Understanding racial differences in outcomes for atrial fibrillation (AF) may guide interventions to diminish health inequities. Methods and Results:In a retrospective, cross-sectional study of adults hospitalized with a principal diagnosis of AF using the 2001-2012 National Inpatient Sample, we assessed racial differences for in-hospital. We accounted for case-mix and clustering by race within hospitals to estimate odds ratios (OR) for death associated with individual patient race and hospital racial composition. We identified 676,567 hospitalizations (mean age 71.8 years, 53.6% women) with principal diagnosis of AF (84.2% White, 7.1% Black, 5.0% Hispanic). Black (vs. White) race was associated with 1.63-fold (95% CI, 1.50-1.78) risk of death. Other races had similar risk of death as Whites. Risk of death for Blacks (vs. Whites) declined over time [2001: OR 1.78(95% CI 1.31-2.43); 2012: OR 1.23(95% CI 0.92-1.64)]. Racial differences in deaths within hospitals narrowed, while hospitals with larger proportions of Blacks had persistently worse outcomes than hospitals with fewer Blacks (OR 1.08 per 10% increase in Blacks in 2001 and 2012). Conclusion:Black patients with a principal diagnosis of AF were more likely to suffer in-hospital death than Whites. Our findings suggest racial disparities based upon individual patients' race improved over time, but outcomes were persistently worse at hospitals with higher proportions of Black patients, regardless of patients' races.

SUBMITTER: Kwan GF

PROVIDER: S-EPMC6472918 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Racial Differences in Hospital Death for Atrial Fibrillation: The National Inpatient Sample 2001-2012.

Kwan Gene F GF Enserro Danielle M DM Benjamin Emelia J EJ Walkey Allan J AJ Wiener Renda Soylemez RS Magnani Jared W JW

ProClinS cardiology 20181214 1

<h4>Background</h4>Understanding racial differences in outcomes for atrial fibrillation (AF) may guide interventions to diminish health inequities.<h4>Methods and results</h4>In a retrospective, cross-sectional study of adults hospitalized with a principal diagnosis of AF using the 2001-2012 National Inpatient Sample, we assessed racial differences for in-hospital. We accounted for case-mix and clustering by race within hospitals to estimate odds ratios (OR) for death associated with individual ...[more]

PMID: 31008458

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Project description:Abstract Background Research has shown mixed results when comparing in‐hospital complications following atrial fibrillation ablation in women compared to men. Objectives To better quantify sex differences and in‐hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes. Methods We queried the NIS database from 2016 to 2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in‐hospital mortality, and complications of women compared to men. Results Admissions for atrial fibrillation were more common in females than males (849 050 vs. 815 665; p < .001). However, females were less likely to receive ablation (1.65% vs. 2.71%, OR: 0.60; 95% confidence interval: 0.57–0.64, p < .001), which persisted after adjusting for cardiomyopathy (adjusted OR: 0.61; 95% confidence interval: 0.58–0.65, p < .001). The primary outcome of in‐hospital mortality was not statistically different in univariate analysis (0.39% vs. 0.36%, OR: 1.09, 95% CI: 0.44–2.72, p = .84), finding that did not change when adjusted for comorbidities (adjusted OR: 0.94, 95% CI: 0.36–2.49). The complication rate in hospitalized patients following ablation was 8.08%. The total unadjusted complication rate was higher for females than males (9.58% vs. 7.09%, p = .001); however, it was not significant when adjusted for risks (adjusted OR: 1.23, 95% CI: 0.99–1.53, p = .06). Conclusion Female sex is not associated with increased complications or death in a real‐world study of catheter ablation when results are adjusted for risks. However, females admitted with atrial fibrillation receive ablation less often than males during hospital admission. Women make up a larger group of admitted atrial fibrillation patients than males. However, women with atrial fibrillation had a 39% lower likelihood of receiving catheter ablation in the hospital when compared to men. In‐hospital mortality was not statistically different between women and men in univariate and multivariate analyses. The total unadjusted complication rate was higher for women than men; however, it was insignificant when adjusted for risks. When controlled for risk factors, female sex was not associated with increased complications or in‐hospital death in a real‐world study.

Project description:Background The purpose of this study was to investigate the prevalence of preexisting atrial fibrillation (AF) in patients with MRSA-BSI during a three-year period and the impact of preexisting AF on MRSA-BSI outcomes. Methods This was a retrospective analysis performed using the National Inpatient Sample (NIS) over a three-year period (2016, 2017, 2018) for patients with MRSA-BSI as a principal diagnosis with and without preexisting AF. The primary outcome was mortality with secondary outcomes of acute coronary syndrome, cardiac arrest, cardiogenic shock, endocarditis, respiratory failure, acute kidney injury, length of stay, hospital cost, and patient charge. A univariate and multivariable logistic regression analysis estimated clinical outcomes. Results Preexisting AF in patients with MRSA-BSI significantly increased the primary outcome of the study, mortality (1.67% vs. 0.66%, p=0.030) with an adjusted odds ratio (AOR) of 1.98 (95% CI, 1.1–3.7). Secondary outcomes showed increased likelihood of cardiac arrest with MRSA-BSI and AF (0.48% vs. 0.2%, p=0.025) with an AOR 3.59 (CI 1.18–11.0), ACS (3.44% vs. 1.21%, p=0.008) with an AOR of 1.81 (CI 1.16–2.80), respiratory failure (8.92% vs. 4.02%, p=0.045) with an AOR 1.39 (CI 1.01–1.91), prolonged LOS (6.4 vs. 5.4 days, p=0.0001), increased hospital cost ($13,374 vs. $11,401, p=0.0001), and increased overall patient charge ($50,091 vs. $43,018, p=0.0001). Secondary outcomes that showed statistical significance included ACS (1,497 (3.44%) vs. 113 (1.21%), p=0.008) with an AOR of 1.81 (CI 1.16–2.80), cardiac arrest (209 (0.48%) vs. 19 (0.2%), p=0.025) with an AOR 3.59 (CI 1.18–11.0), and respiratory failure (3,881 (8.92%) vs. 374 (4.02%), p=0.045 with an AOR 1.39 (CI 1.01–1.91). Conclusions Preexisting AF is a significant risk factor for mortality in patients admitted for MRSA-BSI and increases risk for cardiac arrest, respiratory failure, and ACS. Considerations should focus on early treatment and source control, especially with AF given the mortality risk, increased hospitalization cost, and prolonged LOS.

Dataset Information

Racial Differences in Hospital Death for Atrial Fibrillation: The National Inpatient Sample 2001-2012.

Publications

Racial Differences in Hospital Death for Atrial Fibrillation: The National Inpatient Sample 2001-2012.

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