Abstract
BackgroundPatients with atrial fibrillation-flutter (AF) admitted on the weekends were initially reported to have poor outcomes. The primary purpose of this study is to re-evaluate the outcomes for weekend versus weekday AF hospitalization using the 2014 Nationwide Inpatient Sample (NIS).MethodsIncluded hospitalizations were aged above 18 years. The hospitalizations with AF were identified using the international classification of diseases 9 (ICD-9) codes (427.31, 427.32). In-hospital mortality, length of stay (LOS), other co-morbidities, cardioversion procedures, and time to cardioversion were recorded. All analysis was performed using SAS 9.4 statistical software (Cary, North Carolina).ResultsA total of 453,505 hospitalizations with atrial fibrillation and flutter as primary discharge diagnosis were identified. Among the total hospitalizations with a primary diagnosis of AF, 20.3% were admitted on the weekend. Among the weekend hospitalizations, 0.19% died in hospital compared to 0.74% among those admitted during the week. After adjusting for patient characteristics, hospital characteristics and disease severity, the adjusted odds for in-hospital mortality were not significantly different for weekend vs. weekday hospitalizations (OR = 0.91, 95% CI [0.77–1.11]; p = 0.33). The weekend admissions were associated with significantly lower odds of cardioversion procedures (OR = 0.72, 95% CI [0.69–0.76], P < 0.0001), lower cost of hospitalization (USD 8265.8 on weekends vs. USD 8966.5 on the weekdays, P < 0.001), slightly lower rate of anticoagulation (17.09% on the weekends vs. 18.73% on the weekdays. P < 0.0001), and slightly increased time to cardioversion (1.94 days on the weekend vs. 1.73 days on weekdays, P < 0.0005). The mean length of hospital stay (LOS) was statistically not different in both groups: (3.49 days ± 3.70 (SD) in the weekend group vs. 3.47 days ± 3.50 (SD) in the weekday group, P = 0.42)DiscussionThe weekend AF hospitalizations did not have a clinically significant difference in mortality and LOS compared to those admitted on a weekday. However, the use of cardioversion procedures and cost of hospitalization was significantly lower on the weekends.
Highlights
Atrial fibrillation is the most common persistent cardiac arrhythmia in clinical practice which had an estimated worldwide prevalence of 33.5 million in 2010 (Markides & Schilling, 2003)
We sought to investigate the outcomes in the year 2014 through publically available nationwide inpatient sample database (NIS) to assess the outcomes and to determine whether such differences resulted from the disparities in the utilization and timing of cardioversion
A slightly lower proportion of the white population was hospitalized over the weekends (80.31% on the weekends vs. 82.60% on the weekday), and a higher proportion of the Hispanic population was admitted on the weekends (6.25 on weekends vs. 5.34 on the weekdays, P < 0.0001)
Summary
Atrial fibrillation is the most common persistent cardiac arrhythmia in clinical practice which had an estimated worldwide prevalence of 33.5 million in 2010 (Markides & Schilling, 2003). Patients with atrial fibrillation-flutter (AF) hospitalized on weekends were previously reported to have higher mortality and increased the length of hospital stay (Deshmukh et al, 2012; Shawn Lee et al, 0000). Patients with atrial fibrillation-flutter (AF) admitted on the weekends were initially reported to have poor outcomes. The primary purpose of this study is to re-evaluate the outcomes for weekend versus weekday AF hospitalization using the 2014 Nationwide Inpatient Sample (NIS). The mean length of hospital stay (LOS) was statistically not different in both groups: (3.49 days ± 3.70 (SD) in the weekend group vs 3.47 days ± 3.50 (SD) in the weekday group, P = 0.42) Discussion. The weekend AF hospitalizations did not have a clinically significant difference in mortality and LOS compared to those admitted on a weekday. The use of cardioversion procedures and cost of hospitalization was significantly lower on the weekends
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