Frequency, Trend, Predictors, and Impact of Gastrointestinal Bleeding in Atrial Fibrillation Hospitalizations

Dave, Maneesh; Kumar, Ashish; Majmundar, Monil; Adalja, Devina; Shariff, Mariam; Shah, Prasun; Desai, Rupak; Patel, Krunalkumar; Jagirdhar, Gowthami Sai Kogilathota; Vallabhajosyula, Saraschandra; Gullapalli, Nageshwara; Doshi, Rajkumar

doi:10.1016/j.amjcard.2021.01.020

Cited by 9 publications

(8 citation statements)

References 24 publications

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“…Each admission contains information on patient characteristics, including demographics, comorbidity complications, as well as the primary and secondary discharge diagnoses. This has been explained in detail in previous studies[ 11 - 13 ]. The International Classification of Disease, 10 th revision, Clinical Modification (ICD 10-CM) codes were used to identify diagnosis in the NIS database.…”

Section: Methodsmentioning

confidence: 78%

Burden of atrial fibrillation in patients with rheumatic diseases

Khan¹,

Patel²,

Patel³

et al. 2021

WJCC

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BACKGROUND Studies have suggested that atrial fibrillation (AF) in patients with rheumatic diseases (RD) may be due to inflammation. AIM To determine the highest association of AF among hospitalized RD patients and to determine morbidity and mortality associated with AF in hospitalized patients with RD. METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF. A subgroup analysis was performed comparing outcomes of AF among different RD. RESULTS The prevalence of AF was 23.9% among all patients with RD ( n = 3949203). Among the RD subgroup, the prevalence of AF was highest in polymyalgia rheumatica (33.2%), gout (30.2%), and pseudogout (27.1%). After adjusting for comorbidities, the odds of having AF were increased with gout (1.25), vasculitis (1.19), polymyalgia rheumatica (1.15), dermatopolymyositis (1.14), psoriatic arthropathy (1.12), lupus (1.09), rheumatoid arthritis (1.05) and pseudogout (1.04). In contrast, enteropathic arthropathy (0.44), scleroderma (0.96), ankylosing spondylitis (0.96), and Sjorgen’s syndrome (0.94) had a decreased association of AF. The mortality, length of stay, and hospitalization costs were higher in patients with RD having AF vs without AF. Among the RD subgroup, the highest mortality was found with scleroderma (4.8%), followed by vasculitis (4%) and dermatopolymyositis (3.5%). CONCLUSION A highest association of AF was found with gout followed by vasculitis, and polymyalgia rheumatica when compared to other RD. Mortality was two-fold higher in patients with RD with AF.

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Section: Methodsmentioning

confidence: 78%

Burden of atrial fibrillation in patients with rheumatic diseases

Khan¹,

Patel²,

Patel³

et al. 2021

WJCC

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“… 13–15 The prevalence of GI bleeding among AF patients on anticoagulation is 1–3%. 16 Prior studies have reported higher bleeding rates in patients with AF and cirrhosis (6.89%). 4 We observed a prevalence of GI bleeding among 3% in the overall cohort, higher among the cirrhosis group (4.9%) than among the without-cirrhosis group (2.97%; P = 0.05); however, on adjusted analysis, there was no significant difference in GI bleeding between the groups.…”

Section: Discussionmentioning

confidence: 96%

Left atrial appendage closure device outcomes among cirrhosis patients with atrial fibrillation: a United States National Cohort Study

et al. 2023

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Aims Literature regarding outcomes associated with atrial fibrillation among cirrhosis patients who had left atrial appendage occlusion (LAAO) device procedure is limited. We aim to evaluate the in-hospital clinical outcomes and 30-day readmissions among LAAO with and without cirrhosis. Methods and results We performed a retrospective study of all hospitalizations associated with the LAAO procedure, using the Nationwide Readmissions Database for the years 2016–19. Primary outcomes were in-hospital clinical outcomes and 30-day readmissions. A total of 54 897 index hospitalizations for LAAO (female 41.8%) were reported. Of these, 905(1.65%) had cirrhosis. Gastrointestinal (GI) bleeding was reported in 44 (4.9%) vs. 1606 (2.97%) and coagulopathy in 21 (2.3%) vs. 521 (0.96%) in cirrhosis and without-cirrhosis groups, respectively. A total of 872 (1.59%) patients needed blood transfusion, 24 (2.7%) vs. 848(1.57%) in cirrhosis vs. without-cirrhosis groups (P = 0.047). Fresh frozen plasma (FFP) transfusion was reported among 888 (1.62%), with cirrhosis 26 (3%) vs. without cirrhosis 862 (1.6%) (P = 0.05). On adjusted multivariate logistic regression analysis, acute kidney injury, coagulopathy, FFP transfusion, and blood transfusion were strongly associated with cirrhosis, and GI bleeding, ischaemic stroke, and intracranial haemorrhage were not associated with cirrhosis. Readmissions in 30 days were 5028 (9.18%), 167 (18.5%) in the cirrhosis group and 4861 (9%) without-cirrhosis group (P = 0.01). On multivariate Cox regression, CHA2DS2-Vasc score of six was significantly associated with 30-day readmission compared with other scores [hazard ratio 2.24; 95% confidence interval (1.58–3.16); P < 0.001]. Conclusion Left atrial appendage occlusion procedure in patients with cirrhosis had relatively similar GI bleeding and stroke rates, however, had higher rates of 30-day readmission. A higher CHA2DS2-Vasc score was more likely to be associated with 30-day readmissions and hence would help in discharge planning. The long-term safety and efficacy of LAAO in the cirrhosis population need to be demonstrated.

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“…Each admission contains information on patient characteristics, including demographics, comorbidities, complications, as well as the primary and secondary discharge diagnoses. This has been explained in detail in previous studies 5,6 . The International Classification of Disease, 9th revision, Clinical Modification (ICD 9‐CM) codes were used to identify diagnosis in the NIS database 7 .…”

Section: Methodsmentioning

confidence: 99%

“…This has been explained in detail in previous studies. 5 , 6 The International Classification of Disease, 9th revision, Clinical Modification (ICD 9‐CM) codes were used to identify diagnosis in the NIS database. 7 Data included in this study were obtained between January 2005 and October 2015, as data before October 2015 included the use of ICD‐9‐CM codes.…”

Section: Methodsmentioning

confidence: 99%

Association of atrial fibrillation and various cancer subtypes

Khan

Gupta

Patel

et al. 2021

Journal of Arrhythmia

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Background Studies have shown that the incidence of atrial fibrillation (AF) in cancer is most likely due to the presence of inflammatory markers. The purpose of our study is to determine the association of AF with different cancer subtypes and its impact on in‐hospital outcomes. Methods Data were obtained from the National Inpatient Sample database between 2005 and 2015. Patients with various cancers and AF were studied. ICD‐9‐CM codes were utilized to verify variables. Patients were divided into three age groups: Group 1 (age < 65 years), Group 2 (age 65‐80 years), and Group 3 (age > 80 years). Statistical analysis was performed using Pearson chi‐square and binary logistic regression analysis to determine the association of individual cancers with AF. Results The prevalence of AF was 14.6% among total study patients (n = 46 030 380). After adjusting for confounding variables through multivariate regression analysis, AF showed significant association in Group 1 with lung cancer (odds ratio, OR = 1.92), multiple myeloma (OR = 1.59), non‐Hodgkin lymphoma (OR = 1.55), respiratory cancer (OR = 1.55), prostate cancer (OR = 1.20), leukemia (OR = 1.12), and Hodgkin's lymphoma (OR = 1.03). In Group 2, the association of AF with multiple myeloma (1.21), lung cancer (OR = 1.15), Hodgkin lymphoma (OR = 1.15), non‐Hodgkin lymphoma (OR = 1.12), respiratory cancer (OR = 1.08), prostate cancer (OR = 1.06), leukemia (OR = 1.14), and colon cancer (OR = 1.01) were significant. In Group 3, AF showed significant association with non‐Hodgkin lymphoma (OR = 1.06), prostate (OR = 1.03), leukemia (OR = 1.03), Hodgkin's lymphoma (OR = 1.02), multiple myeloma (OR = 1.01), colon cancer (OR = 1.01), and breast cancer (OR = 1.01). The highest mortality was found in lung cancer in age <80 and prostate cancer in age >80. Conclusion In patients age <80 years, AF has significant association with lung cancer and multiple myeloma, whereas in patients age >80 years, it has significant association with non‐Hodgkin lymphoma and prostate cancer. In patients age <80 years, increased mortality was seen in AF with lung cancer and in patients age >80 years, increased mortality was seen in those with AF and prostate cancer. Twitter Abstract In age <80, lung cancer and multiple myeloma have a strong association with AF while thyroid and pancreatic cancers have no association with AF at any age. In age greater than 80, NHL and prostate cancer have a significant association with AF.

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Frequency, Trend, Predictors, and Impact of Gastrointestinal Bleeding in Atrial Fibrillation Hospitalizations

Cited by 9 publications

References 24 publications

Burden of atrial fibrillation in patients with rheumatic diseases

Burden of atrial fibrillation in patients with rheumatic diseases

Left atrial appendage closure device outcomes among cirrhosis patients with atrial fibrillation: a United States National Cohort Study

Association of atrial fibrillation and various cancer subtypes

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