Abstract 14390: Regional Variations in Atrial Fibrillation Hospitalizations

Abstract

Introduction: Atrial fibrillation is a common diagnosis that affects several millions of Americans yearly. Our goal is to criticize if and why geographical location could affect the outcome of a-fib management. We hope to determine if a region holds superiority in the management and outcome of A-fib patients and to understand why. Analysis with the National Inpatient Sample divided the United States into four groups the Northwest, Mid-west, South, and West. We analyzed and compared the regions in terms of the overall outcome. Methods: Data obtained from the Nationwide Inpatient Sample database from 2016 and 2017. We included data on all adult patients (aged 18 and above) hospitalized with a principal diagnosis of A-fib using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes had total death, length of hospital stay, total hospital charges, cost of hospitalization. Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charleston comorbidity index, and hospital characteristics as confounders. Results: A total of 821,629.5 hospitalizations were for Atrial fibrillation. The Northeast (NE) region had 165,695 patients, the Midwest (MW) had 198,324.9, the South had 333,849.8, and the West had 123,759.8 of the total Atrial fibrillation hospitalizations. A-fib was higher in females overall (51.06%). There was significant racial variation across regions, with the South having the highest proportion of Blacks (10.36%) while the West had the highest proportion of Hispanics (12,84%). Inpatient mortality for A-fib was 0.09%. There was no significant difference in the adjusted odds ratio for mortality across the regions. Compared to the NE, the MW and W had decreased mean LOS (-0.29, 95% CI: -0.35 - [-0.22], p=0.000 and -0.42, 95% CI: -0.51 - [-0.33], p=0.000 respectively) in days. Conclusions: In conclusion, although A-fib outcomes across all US regions are relatively uniform, local regional differing effects may play a role in the delivery of care to patients. For example, we noticed that the mortality rate was much more significant in the West when compared to the other three regions. This study aims to identify and explain the varying outcomes in management to decrease all round mortality in all regions.