Atrial fibrillation associated hospitalizations in patients with end-stage renal disease in the United States, 2003–2012

Abstract

Atrial fibrillation (AF) is highly prevalent in patients with end-stage renal disease (ESRD). The clinical and economic burden of AF-associated hospitalizations has not been previously quantified in the ESRD population in the United States. The aim of this study was to assess the incidence and outcomes of AF hospitalizations in the US ESRD population. We used the 2003-2012 National Inpatient Sample database to study trends in the incidence and outcomes of AF hospitalizations in ESRD patients. Primary outcomes included hospitalization rate, in-hospital case fatality ratio (CFR), length of stay (LOS), and cost. There were 66,811 primary and 986,742 secondary AF hospitalizations associated with ESRD. The mean age of the patients was 70.9 years, and 45.2% were women. The age-adjusted primary AF hospitalization rate increased from 10.1 to 14.0 per 1000 ESRD patients, while the secondary AF hospitalization rate increased from 164.0 to 212.8 per 1000 ESRD patients (P-trend < 0.05 for both). There was a significant decrease in CFR (2.9%-2.7% for primary AF and 11.3%-7.7% for secondary AF; P-trend < .001 for both), mean LOS (6.0-4.8 days for primary AF and 9.8-7.1 days for secondary AF; P-trend < .001 for both), and mean cost ($14,395-$11,184 for primary AF and $25,545-$17,879 for secondary AF; P-trend < .001 for both). There was a greater than 2-fold increase in the annual number of AF hospitalizations along with a significant increase in AF hospitalization rate in the US ESRD population. There were significant improvements in markers of quality of care, including inhospital CFR, LOS, and cost.