Author + information
- Subir Bhatia,
- Sravya Mallam,
- Vivek Singh,
- Kanishk Agnihotri,
- Shilpkumar Arora,
- Parshva Patel,
- Peter Noseworthy,
- Suraj Kapa,
- Sidakpal Panaich,
- Nileshkumar Patel,
- Apurva Badheka,
- Nilay Patel and
- Abhishek Deshmukh
Background: Cardiovascular disease continues to be a major cause of morbidity and mortality in cirrhotic patients. Liver disease is associated with thrombocytopenia and coagulopathy while anticoagulant use for atrial fibrillation (AF) is associated with bleeding risk. However, whether cirrhosis with concomitant AF is associated with poor outcomes is not known.
Methods: Using the 2002-2012 National Inpatient Sample, the largest publicly available in-patient care database representing more than 95% of the US population, we extracted data using ICD 9 codes 571.2, 571.5, 571.6 (cirrhosis) as the primary diagnosis and ICD 9 code 427.31 (AF) as the secondary diagnosis. We excluded patients with missing information on age, sex, and mortality for a final sample size of 241,950. We used multilevel logistic and linear regression models with random effect to adjust for confounding. Our primary outcome was in-hospital mortality.
Results: Among 241,950 hospitalizations for cirrhosis, 12,197 had AF (5.3%). Compared with cirrhotic patients without AF, cirrhotic patients with AF were older and more likely to have a history of hypertension, diabetes, heart failure, COPD, renal failure, and obesity. Overall in-hospital mortality was 7.3% in cirrhotic patients without AF and 10.2% with AF and cirrhosis (p<.0001). Multivariable adjusted analysis revealed cirrhotic patients with AF had 1.4 higher odds of dying in-hospital compared to cirrhotic patients without AF. At CHADS2 scores of 0-2, the rate of bleeding requiring transfusion was higher in cirrhotic patients without AF, but at CHADS2 scores of 3 and greater, the rate of bleeding requiring transfusion was higher in cirrhotic patients with AF.
Conclusions: AF occurred in 5.3% of patients hospitalized for cirrhosis from 2002-2012. Cirrhotic patients with AF had higher odds of dying compared to cirrhotic patients without AF. The rate of bleeding requiring transfusion was higher in cirrhotic patients with AF at CHADS2 scores of 3 and greater.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovative Approaches for Reducing Risk and Improving Outcomes With Ablation
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1237-100
- 2017 American College of Cardiology Foundation