Bindu Kalesan1, Amartya Kundu2, Aditya Vaze3, Elizabeth Pino1, Allan J Walkey4, Ramachandran S Vasan4, David D McManus2. 1. Center for Translational Epidemiology and Comparative Effectiveness Research and Department of Community Health Sciences, Boston University School of Medicine and Public Health, Boston, Massachusetts. 2. Department of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts. 3. Department of Cardiology, University of California Irvine School of Medicine, Irvine, California. 4. Division of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Patients with atrial fibrillation (AF) are at risk for both thromboembolic and bleeding complications. While the risk for thromboembolism is higher among women with AF than men, the sex-related differences in post-discharge outcomes after hospitalization is not clearly understood. HYPOTHESIS: Compared to men, women hospitalized for AF are at a higher risk of both thromboembolic and bleeding complications. METHODS: We conducted a retrospective cohort study using data from the 2013 to 2014 Nationwide Readmission Database (NRD), to compare outcomes among men and women, ≥50 years of age after hospitalization for AF. The primary patient outcome was all-cause rehospitalization at 90-days after initial hospitalization. Survey-weighted Cox proportional hazard regression models were used to estimate the hazard ratios (HR) and their 95% confidence intervals (CI) for bleeding events at 30, 60, 90, and 270 days after hospitalization. RESULTS: From the 28 million patients in the NRD, we identified 522 521 individuals with an index hospitalization for AF. Compared to men, women hospitalized for AF accounted for 53.3% of the cohort and had higher rates of thrombotic (1.7%, 1.4%) and bleeding complications (1.4%, 1.1%). After adjustment, the 90-day risk among women vs men was significantly greater; all-cause rehospitalization (24.2%, 17.0%; HR = 1.07, 95% CI = 1.05-1.09), rehospitalization related to ischemic stroke (0.6%, 0.3%; HR 1.31, 95% CI = 1.14-1.51), pulmonary embolism (0.4%, 0.2%; HR 1.21, 95% CI = 1.01-1.45), and any thrombotic event (1.3%, 0.7%; HR 1.20, 95% CI = 1.09-1.32). CONCLUSIONS: Hospitalization for AF is common and frequently associated with both in-hospital complications and readmission, which were more commonly observed among women with AF. Further research into epidemiological factors and treatment differences between men and women with AF is warranted.
BACKGROUND:Patients with atrial fibrillation (AF) are at risk for both thromboembolic and bleeding complications. While the risk for thromboembolism is higher among women with AF than men, the sex-related differences in post-discharge outcomes after hospitalization is not clearly understood. HYPOTHESIS: Compared to men, women hospitalized for AF are at a higher risk of both thromboembolic and bleeding complications. METHODS: We conducted a retrospective cohort study using data from the 2013 to 2014 Nationwide Readmission Database (NRD), to compare outcomes among men and women, ≥50 years of age after hospitalization for AF. The primary patient outcome was all-cause rehospitalization at 90-days after initial hospitalization. Survey-weighted Cox proportional hazard regression models were used to estimate the hazard ratios (HR) and their 95% confidence intervals (CI) for bleeding events at 30, 60, 90, and 270 days after hospitalization. RESULTS: From the 28 million patients in the NRD, we identified 522 521 individuals with an index hospitalization for AF. Compared to men, women hospitalized for AF accounted for 53.3% of the cohort and had higher rates of thrombotic (1.7%, 1.4%) and bleeding complications (1.4%, 1.1%). After adjustment, the 90-day risk among women vs men was significantly greater; all-cause rehospitalization (24.2%, 17.0%; HR = 1.07, 95% CI = 1.05-1.09), rehospitalization related to ischemic stroke (0.6%, 0.3%; HR 1.31, 95% CI = 1.14-1.51), pulmonary embolism (0.4%, 0.2%; HR 1.21, 95% CI = 1.01-1.45), and any thrombotic event (1.3%, 0.7%; HR 1.20, 95% CI = 1.09-1.32). CONCLUSIONS: Hospitalization for AF is common and frequently associated with both in-hospital complications and readmission, which were more commonly observed among women with AF. Further research into epidemiological factors and treatment differences between men and women with AF is warranted.
Authors: Emily C O'Brien; Sunghee Kim; Paul L Hess; Peter R Kowey; Gregg C Fonarow; Jonathan P Piccini; Eric D Peterson Journal: JAMA Intern Med Date: 2015-05 Impact factor: 21.873
Authors: Amartya Kundu; Kevin O Day; Darleen M Lessard; Joel M Gore; Steven A Lubitz; Hong Yu; Mohammed W Akhter; Daniel Z Fisher; Robert M Hayward; Nils Henninger; Jane S Saczynski; Allan J Walkey; Alok Kapoor; Jorge Yarzebski; Robert J Goldberg; David D McManus Journal: J Atr Fibrillation Date: 2018-02-28