Divergent Temporal Trends in Morbidity and Mortality Related to Heart Failure and Atrial Fibrillation: Age, Sex, Race, and Geographic Differences in the United States, 1991–2015

Atrial fibrillation is now the most common cardiac arrhythmia for which a patient is hospitalized. Clinically, it presents in a form that is paroxysmal, persistent, or permanent and may be symptomatic or asymptomatic, occurring in the setting of either no cardiac disease (“lone atrial fibrillation”) or, most often, in association with an underlying disease. Atrial fibrillation is associated with a 2-fold increase in mortality and, in the United States alone, causes over 75,000 cases of stroke per year. The annual prevalence of stroke is 5% to 7%, but the use of adequate anticoagulation can reduce this to less than 1%. Atrial fibrillation is a disorder of the elderly, with almost equal prevalence in men and women. In the United States, 80% of atrial fibrillation occurs in patients over the age of 65 years, and its prevalence tracks that of heart failure, which may be the cause, as well as the result, of the arrhythmia. Both conditions are increasing in epidemic proportions in the aging population. The most common causes of atrial fibrillation are hypertensive heart disease, coronary artery disease, and heart failure with a miscellany of lesser conditions, with about 10% lacking structural heart disease. Unlike other supraventricular arrhythmias, cure by the use of catheter ablation and surgical techniques has not been a reality except in a relatively small number of cases. However, restoration and maintenance of sinus rhythm remain the initial goal of therapy for most patients. Pharmacologic approaches remain the mainstay of therapy for rate control and anticoagulation as well as for maintenance of sinus rhythm following pharmacological or electrical conversion. The changing epidemiology of atrial fibrillation is highlighted, with the focus on its conversion by the use of newer and novel antifibrillatory agents relative to the mechanisms of the arrhythmia, to restore the stability of sinus rhythm.

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Abstract 2157: Racial Differences in Hospitalizations for Atrial Fibrillation in the United States

Circulation ◽

10.1161/circ.118.suppl_18.s_677-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Paul B Tabereaux ◽

Todd M Brown ◽

Jose Osorio ◽

G. N Kay ◽

Dawn M Bravada

Keyword(s):

Diabetes Mellitus ◽

United States ◽

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischemic Heart Disease ◽

The United States ◽

Principal Diagnosis ◽

Common Risk Factors

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the United States; however a paucity of population-based data about nonwhite individuals exist. The objectives of this study were to compare hospitalizations among Whites and African Americans (AA) and to determine whether race is an independent predictor of hospitalization for AF in the United States. Methods: Data was obtained from the National Hospital Discharge Survey (years 1996 –2005) and included hospitalizations with a principal diagnosis of AF for patients aged ≥18 yrs and race designated as either White or AA. Codes from the International Classification of Diseases -9th revision were used to define AF (427.31), hypertension (401– 405), ischemic heart disease (410 – 414), diabetes mellitus (250), heart failure (425,428) and valvular heart disease (424). Multivariable analysis with logistic regression was used to identify factors that were independently associated with AF hospitalizations Results: Among 297,962,043 hospitalizations between 1996 –2005, 3,676,787 (1.2%) had a principal diagnosis of AF. Among the hospitalizations for AF, white race was more common than AA race (2,393,659/186,904,962 of whites (1.3% of white’s hospitalized) and 209,788/33,972,665 of African Americans (0.6% of AA’s hospitalized), p<0.0001). After adjusting for the most common risk factors for AF (age, sex, hypertension, ischemic heart disease, diabetes mellitus, heart failure and valvular heart disease) AA race was independently associated with a decreased odds of hospitalizations for AF (Table 1 : adjusted OR=0.49, 95%CI 0.46 – 0.51). Conclusions: After adjusting for the most common risk factors for AF, the odds of hospitalization for AF in AA’s remained half that of whites. Race may be a novel and unaccounted risk factor for atrial fibrillation.

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Cardiac Arrest during Hospitalization for Delivery in the United States, 1998–2011

Anesthesiology ◽

10.1097/aln.0000000000000159 ◽

2014 ◽

Vol 120 (4) ◽

pp. 810-818 ◽

Cited By ~ 98

Author(s):

Jill M. Mhyre ◽

Lawrence C. Tsen ◽

Sharon Einav ◽

Elena V. Kuklina ◽

Lisa R. Leffert ◽

...

Keyword(s):

United States ◽

Heart Failure ◽

Cardiac Arrest ◽

Amniotic Fluid ◽

Cardiopulmonary Arrest ◽

Temporal Trends ◽

Survival Rates ◽

The United States ◽

Amniotic Fluid Embolism ◽

Weighted Estimates

Abstract Background: The objective of this analysis was to evaluate the frequency, distribution of potential etiologies, and survival rates of maternal cardiopulmonary arrest during the hospitalization for delivery in the United States. Methods: By using data from the Nationwide Inpatient Sample during the years 1998 through 2011, the authors obtained weighted estimates of the number of U.S. hospitalizations for delivery complicated by maternal cardiac arrest. Clinical and demographic risk factors, potential etiologies, and outcomes were identified and compared in women with and without cardiac arrest. The authors tested for temporal trends in the occurrence and survival associated with maternal arrest. Results: Cardiac arrest complicated 1 in 12,000 or 8.5 per 100,000 hospitalizations for delivery (99% CI, 7.7 to 9.3 per 100,000). The most common potential etiologies of arrest included hemorrhage, heart failure, amniotic fluid embolism, and sepsis. Among patients with cardiac arrest, 58.9% of patients (99% CI, 54.8 to 63.0%) survived to hospital discharge. Conclusions: Approximately 1 in 12,000 hospitalizations for delivery is complicated by cardiac arrest, most frequently due to hemorrhage, heart failure, amniotic fluid embolism, or sepsis. Survival depends on the underlying etiology of arrest.

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Temporal Trends in Hospitalization for Acute Decompensated Heart Failure in the United States, 1998–2011

American Journal of Epidemiology ◽

10.1093/aje/kwv455 ◽

2016 ◽

Vol 183 (5) ◽

pp. 462-470 ◽

Cited By ~ 20

Author(s):

Sunil K. Agarwal ◽

Lisa Wruck ◽

Miguel Quibrera ◽

Kunihiro Matsushita ◽

Laura R. Loehr ◽

...

Keyword(s):

United States ◽

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Temporal Trends ◽

Decompensated Heart Failure ◽

The United States

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Abstract WMP49: Temporal Trends in the Burden of Atrial Fibrillation in Acute Ischemic Stroke and Transient Ischemic Attack in the United States

Stroke ◽

10.1161/str.47.suppl_1.wmp49 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Fadar O Otite ◽

Priyank Khandelwal ◽

Seemant Chaturvedi ◽

Jose G Romano ◽

Ralph L Sacco ◽

...

Keyword(s):

United States ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Transient Ischemic Attack ◽

Large Scale ◽

Temporal Trends ◽

The United States ◽

Hospital Size ◽

Ischemic Attack

Background: Large scale data on atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) is sparse since approval of dabigatran for non-valvular AF in 2010. We studied recent trends in prevalence of AF in AIS and transient ischemic attack (TIA) in the United States (US) and association of AF with in-hospital mortality, cost and length of stay (LOS) in AIS. Methods: Adults admitted to US hospitals from 2007-2012 with diagnosis of AIS (n=3,427,806) and TIA (n=502,820) were identified from the Nationwide Inpatient Sample. Weighted prevalence of AF in AIS and TIA by demographics and region was computed. Multivariate logistic regression was used to evaluate association of AF with other clinical factors and mortality in AIS. Association of AF with LOS and cost was assessed using generalized linear models. Results: AF prevalence increased by 11.5% in AIS (22%-24.5%, p<0.001) and by 29% in TIA (13.5%-17.4%, p<0.001) from 2007-2012. AF prevalence varied by age (AIS: 7% in 50-59yo vs 38% in >80yo; TIA: 5% in 50-59yo vs 27% in >80yo), sex (AIS: 20% in M vs 25% in F); TIA: 16% in M vs 15% in F), race (AIS: whites 26% vs blacks 12%) and region (AIS: Northeast 25% vs South 21%). AF prevalence increased in all subgroups over time (p<0.001) except AIS <40yo and TIA<50yo (Figure 1). Advancing age, female sex, white race, high income, Medicare insurance, CHA 2 DS 2 -VASc score and large hospital size were associated with increased odds of AF in AIS. AF was positively associated with death (OR=1.60, 95%CI 1.56-1.64) but mortality in AIS with AF decreased from 13.2% in 2007 to 10.7% in 2012 (p<0.001). AF was associated with increased cost of $2,631 and LOS 1.1 days in AIS. Conclusion: Prevalence of AF in AIS and TIA has continued to increase. Disparity in AF prevalence in AIS and TIA exists by patient and hospital factors. AF is associated with increased mortality, LOS and hospital cost in AIS but mortality in AIS with AF is decreasing. More AIS preventive efforts are needed in AF patients especially in the elderly.

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