National Trends in Atrial Fibrillation Hospitalizations, Readmissions, and Mortality, 2010 to 2022

Abstract

Background Atrial fibrillation (AF) is a leading cause for acute cardiovascular hospitalizations. There is limited contemporary data about national trends and risk factors that predict readmission and mortality. Objectives The objective of the study was to identify national trends in hospitalizations, readmissions, and inpatient mortality during index admission for AF. Methods Using nationally representative, survey-weighted hospitalization data, we assessed AF hospitalization trends and calculated risk factors for 30-day readmission and in-hospital mortality using cluster-adjusted multivariable logistic regression. Results Between 2010 and 2022, there were 6,141,046 primary AF hospitalizations among 5,528,397 unique patients, of which 892,254 (16.1%) experienced 30-day readmission and 53,084 (0.96%) deaths during index admission. Renal disease was the strongest predictor of both 30-day readmission (adjusted OR: 1.39; 95% CI: 1.37-1.40) and in-hospital mortality (adjusted OR: 3.98; 95% CI: 3.85-4.11); public insurance was also strongly associated with adverse outcomes, including Medicare (readmission OR: 1.46; mortality OR: 1.17) and Medicaid coverage (readmission OR: 1.62; mortality OR: 1.43), along with lower income quartile, chronic obstructive pulmonary disease (readmission OR: 1.48; mortality OR: 1.66), heart failure (readmission OR: 1.38; mortality OR: 1.83), prior myocardial infarction (readmission OR: 1.26; mortality OR: 3.34), and female sex (readmission OR: 1.12; mortality OR: 1.07). Total cost of AF hospitalizations in 2022 was $7.2 billion. Conclusions In the United States, AF hospitalizations and readmissions experienced a modest overall net increase from 2010 to 2022, with a notable decline from 2014 to 2020 before rebounding following the COVID-19 pandemic, and 30-day readmissions and in-hospital mortality were associated with age, comorbidities, and socioeconomic factors.