Abstract 10093: Association Between B-Thalassemia and Atrial Fibrillation: Insights From the United States National Inpatient Sample

Abstract

Introduction: β-thalassemia (BT) disease requires a lifelong blood transfusion. Despite improved prognosis with transfusion and chelation therapy, the iron overload can predispose to atrial fibrillation (AF). We sought to study the impact of AF on BT patients through large database analysis. Methods: The study used the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) for 2016-2019. Adult BT admissions were included. BT admissions were identified using ICD-10 code (D56.1). Admissions were stratified according to AF presence. A series of multivariate logistic regression was performed to evaluate the impact of atrial fibrillation on BT and to account for potential confounders. Continuous variables were compared using Student t-test, and categorical variables were compared using ꭓ2 tests. Subgroup analysis according to sex was performed. Outcomes evaluated were in-hospital mortality and prolonged length of stay (LOS) ≥ 75th percentile. Results: A total of 17,150 admissions were included, of which 2,100 (12.2%) had an associated diagnosis of AF. Admissions with AF were older (72.1 vs 47.3, P<0.001), white race (66% vs 41%), and more likely to have congestive heart failure (CHF), hypertension, valvular heart disease, and renal disease. BT was associated with higher AF prevalence than non-BT admissions across all age groups. AF was not associated with increased risk of in-hospital mortality in the general cohort nor increased LOS (adjusted odds ratio [aOR]: 1.36 [0.67-2.78], P=0.398, and 1.00 [0.78-1.29], P=0.997, respectively). In subgroup analysis, including only female admissions, AF was associated with increased in-hospital mortality (aOR: 2.73 [1.09-6.8], P=0.031) but not with prolonged LOS (P=0.218). Predictors of in-hospital mortality were age, CHF, and liver disease, while predictors of prolonged LOS were Diabetes Mellitus in addition to CHF and age. Conclusions: We reported significant findings. First, AF is more common in BT compared to the general population, irrespective of age. Second, AF was independently associated with increased mortality in BT females. Third, CHF, liver disease, diabetes, and increased age are poor outcome predictors.