Cirrhosis is a risk factor for atrial fibrillation: A nationwide, population‐based study

Lee, Hyun Jung; Rhee, Tae Min; Lee, So‐Ryoung; Lim, Woo Hyun; Kang, Si Hyuck; Han, Kyung Do; Jin, Myung; Oh, Seil

doi:10.1111/liv.13459

Cited by 61 publications

(58 citation statements)

References 26 publications

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“…In this study, we found that the prevalence of AF was 7.48% in hospitalized ESLD patients, consistent with existing studies indicating a prevalence range of 0.15%‐12.50% in cirrhotic patients . In particular, meta‐analysis by Chokesuwattanaskul et al reported that the estimated prevalence of AF among patients with cirrhosis is 5.0% .…”

Section: Discussionsupporting

confidence: 91%

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Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

Han

Qin

et al. 2019

Liver International

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Background & Aims End‐stage liver disease (ESLD) happens due to the development and progression of chronic liver disease. This study aims to investigate the temporal trend, patient characteristics and outcomes of atrial fibrillation (AF) in hospitalized ESLD patients across the United States. Methods Nationwide Inpatient Sample from 2003 to 2014 was utilized to retrospectively study the weighted prevalence of AF in hospitalized ESLD patients. Multivariable regression models were used to assess the association between AF with clinical factors, in‐hospital mortality, length of stay (LOS) and cost. Results 639 345 hospitalizations associated with ESLD were identified, of which 47 710 (7.48%) were diagnosed with AF. The prevalence of AF increased from 5.73% in 2003 to 9.75% in 2014 in ESLD and varied by age, race, income, insurance type and hospital characteristics. Factors associated with AF included advancing age, male, white race, high income and urban teaching hospital. AF presence was associated with significant higher in‐hospital mortality (odds ratio, 1.40; 95% confidence interval, 1.35‐1.45), 21% longer LOS and 22% higher cost. In addition, a significant decreasing trend in in‐hospital mortality was observed (from 16.70% to 10.63% in patients with AF and from 10.74% to 7.50% in patients without AF). Conclusions The prevalence of AF in hospitalized ESLD patients has continued to increase from 2003 through 2014. AF is associated with poor prognosis and higher health resource utilization. Innovative anticoagulation strategies through improved collaboration between cardiologists and hepatologists are required for better management of hospitalized ESLD patients comorbid with AF.

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Section: Discussionsupporting

confidence: 91%

“…Prevalence of AF in the general population is approximately 1%‐2% in the US . However, regarding the incidence and prevalence of AF in patients with liver cirrhosis, existing publications yielded inconsistent results . Some data suggested that cirrhosis might confer a protective effect against the occurrence of AF .…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

Han

Qin

et al. 2019

Liver International

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“…Thus, insulin and sulfonylurea were used for the analysis. The subjects’ medical history, including the chronic obstructive pulmonary disease (COPD, J43–J44), all types of cancer (C00–C97), liver cirrhosis (K704, K746), end-stage renal disease (ESRD, N18, N19, Z49, Z905, Z94, and Z992 of ICD-10 code and R380, O7011–7020, O7017, and O7075 of the procedure code), and cardiovascular diseases (I21, I22, I63, and I64), was identified using the ICD-10 codes [11, 12]. BMI was calculated as weight in kilograms divided by the square of height in meters (kg/m²).…”

Section: Methodsmentioning

confidence: 99%

Association between BMI and risk of severe hypoglycaemia in type 2 diabetes

Yun

Park

Han

et al. 2019

Diabetes & Metabolism

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“…On the other hand, Lee et al. focused on new‐onset AF and found a 46% relatively higher risk of AF in cirrhotic patients compared with noncirrhotic patients 6. Given the small number and controversial results of these previous studies, we hypothesized that severity of liver disease, as assessed by MELD score, would be independently associated with new‐onset AF.…”

Section: Discussionmentioning

confidence: 95%

“…An elevated risk of atrial fibrillation (AF) among patients with liver disease and structurally normal hearts seems plausible given that inflammation and autonomic dysfunction have been shown to contribute to pathogenesis of AF 5. However, studies on incidence and prevalence of AF in patients with liver disease are few and have shown mixed results 6, 7. In addition, results of these studies have been confounded by the lack of assessment of liver disease severity in the specific population studied.…”

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confidence: 99%

Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

Huang

Dunipace

Sorg

et al. 2018

JAHA

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BackgroundImpact of liver disease on development of atrial fibrillation (AF) is unclear. The purpose of the study was to evaluate prevalence of AF in the setting of liver disease and whether increasing severity of liver disease, using Model for End‐Stage Liver Disease (MELD), is independently associated with increased risk of AF.Methods and ResultsRetrospective data analysis of 1727 patients with liver disease evaluated for liver transplantation between 2006 and 2015 was performed, and patient characteristics were analyzed from billing codes and review of medical records. Multivariable time‐dependent Cox proportional hazards model was performed to determine effect of increasing MELD score on risk of developing AF. Prevalence of AF was 11.2%. Incidence of AF at median follow‐up time of 1.04 years was 8.5%. Both prevalence and incidence of AF increased with increasing MELD scores. Prevalence of AF was 3.7%, 6.4%, 16.7%, and 20.2% corresponding with MELD quartiles 1 to 10, 11 to 20, 21 to 30, and >30, respectively. Compared with patients with MELD quartile 1 to 10, patients with MELD quartile of 11 to 20 had hazard ratio of 2.73 (confidence interval, 1.47–5.07), those in the MELD quartile of 21 to 30 had a hazard ratio of 5.17 (confidence interval, 2.65–10.09), and those with MELD values >30 had hazard ratio of 9.33 (confidence interval, 3.93–22.14) for development of new‐onset AF. Other significant variables associated with new‐onset AF were age, sleep apnea, valvular heart disease, hemodynamic instability, and reduced left ventricular ejection fraction <50% (hazard ratio, of 1.06, 2.17, 3.21, 2.00, and 2.44, respectively).ConclusionsPrevalence and incidence of AF in patients with liver disease is high. Severity of liver disease, as measured by MELD, is an important predictor of new‐onset AF. This novel finding suggests an interaction between inflammatory and neurohormonal changes in liver disease and pathogenesis of AF.

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Cirrhosis is a risk factor for atrial fibrillation: A nationwide, population‐based study

Cited by 61 publications

References 26 publications

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

Association between BMI and risk of severe hypoglycaemia in type 2 diabetes

Liver Disease as a Predictor of New‐Onset Atrial Fibrillation

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