Abstract 131: The Effect of Atrial Fibrillation on the Outcomes and Prognosis of Pulmonary Embolism, a Report From the National Inpatient Sample of 2016

Abstract

Introduction: Atrial fibrillation (AF) and pulmonary embolism (PE) have many shared risk factors. A number of studies have shown that PE is associated with higher risk of AF incidence. Recent literature has also shown that AF can increase the risk of PE and is potentially associated with worse prognosis, however these studies are limited. Methods: This is a retrospective cohort study based on the 2016 National Inpatient Sample of adults (>18 years) hospitalized for PE as the primary admitting diagnosis and AF as a secondary concomitant diagnosis based on ICD-10 codes. All-cause mortality was our primary outcome while the rate of thrombolytic agents use, mortality following thrombolytic agents administration, CPR utilization, the rate of endotracheal intubation (ET) and mechanical ventilation (MV), length of stay and mean total hospital charge were the secondary outcomes. We used multivariate regression adjusted for age, sex, race, hospital size, hospital location, hospital teaching status, diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, smoking status, chronic kidney disease and Charlson comorbidity index. We used STATA-15 for statistical analysis. Results: We identified 185,285 patients admitted for PE in 2016, of whom 13,570 patient had concomitant AF. Mean age was 62 years and 52.4% were females. Our results showed, table 1, that PE with concomitant AF compared to PE without AF significantly increased the risk of all-cause mortality in PE patients (6.96% vs 2.61%, OR 1.99 [1.66-2.39], p <0.001), was associated with higher rate of ET and MV (3.94% vs 1.94%, OR 1.78 [1.41-2.24], p <0.001), had higher CPR utilization (1.73% vs 0.87%, OR 1.86 [1.32-2.63], p <0.001), had a higher mean total hospital charge (54583 $ vs 43880$, p <0.001) and had a longer mean length of stay (5.58 days vs 4.36 days, p <0.001). The rate of thrombolytic agents administration was not significantly different (2.58% vs 2.73%, OR 0.99 [0.75-1.32], p=0.997) but all-cause mortality following thrombolytic agents use was higher for those with AF (0.81% vs 0.35%, OR 2.74 [1.46-5.17], p=0.002). Conclusion: AF appears to be an independent risk factor for higher all-cause mortality and worse in-hospital outcomes in PE patients. More studies are needed to further evaluate AF as a potential risk stratifying factor for PE prognosis.