S1327 Nonalcoholic Steatohepatitis and Atrial Fibrillation: Baseline Characteristics and Outcomes: A Propensity-Matched Analysis From National Inpatient Sample Database

Abstract

Introduction: Non-alcoholic steatohepatitis (NASH) affects at least 3 to 5% of Americans, which imposes a higher risk of concurrent cardiovascular diseases including arrhythmias, of which atrial fibrillation (Afib) is the most prevalent. Nonetheless, data on the burden of concurrent Afib in NASH patients is still lacking. Our aim is to define baseline characteristics of NASH patients with and without Afib and related in-hospital outcomes such as mortality, length of stay (LOS), and total hospital costs. Methods: Using the National Inpatient Sample database, we analyzed all NASH-related adult hospitalizations with or without Afib from September 2015 to December 2020. We applied propensity score matching to the 2 groups to balance baseline characteristics. SAS 9.4 software was used for statistical analysis. Results: Out of 435,845 NASH hospitalizations, 62,335 (14.3 %) had concurrent Afib. The NASH with Afib cohort consisted of older patients (mean age, 69.4 vs. 60.6 years) compared to those without Afib (p< 0.001). NASH with the Afib cohort had more females (54.5%) and Caucasians (82.5%). NASH patients with Afib had an almost 3-times higher prevalence of congestive heart failure (52.5% vs. 17.1%)(p< 0.001) and almost 2-times higher prevalence of coronary artery disease (40.2% vs. 20.2%), Peripheral vascular disease (7.5% vs 4.1%), and Renal failure (42.6% vs 24.7%) (p< 0.001). Moreover, NASH patients with Afib had higher prevalence of hypertension (65.7% 61.9%), Diabetes mellitus (64% vs 60.9%), COPD (28.5% vs 21.2%), and obesity (39.3% vs 36.3%). Compared to the NASH without Afib cohort, the NASH with Afib cohort had higher mortality (6.5% vs. 4.1%) with a mortality-adjusted odds ratio of 1.63 (95% CI: 1.55-1.71) (p< 0.001). In addition, the mean LOS (6.8 vs. 5.9), and mean hospital cost ($ 18701 vs. $16,220) were also higher (p< 0.001). (Figure) (Table) Conclusion: Our results indicate a higher burden imposed by the presence of Afib in NASH patients. The NASH with Afib cohort had significantly higher in-hospital mortality, mean length of stay, and hospitalization cost. This conclusion supports the need for further studies to better illustrate the pathogenesis, early diagnosis, possible preventive measures, and treatment modalities tailored towards NASH-associated Afib.Figure 1.: A) Racial disparity in NASH with Afib and NASH without Afib. B) Propensity mathced outcomes. C) Comorbidity in Nash with Afib and NASH without Afib Table 1. - Baseline characteristics, comorbidities and Outcomes of NASH patients with Afib versus NASH patients without Afib Variables NASH with AfibN=62,335(14.3%) NASH without AfibN=373,510(85.7%) P- Value Age, in years (Mean ± SD) 69.4 ± 10.2 60.6 ± 13.2 < 0.001 Age groups, % < 0.001 18 - 34 years 0.4% 4.6% 35 – 49 years 3.3% 14.1% 50 – 64 years 24.5% 38.6% 65 - 79 56.0% 37.5% >79 years 15.8% 5.1% Gender, % < 0.001 Male 45.5% 36.8% Female 54.5% 63.2% Race, % < 0.001 Caucasians 82.0% 73.5% African Americans 3.5% 4.3% Others 14.5% 22.2% Comorbidities, % Hypertension 65.7% 61.9% < 0.001 Diabetes mellitus 64% 60.9% < 0.001 Congestive heart failure 52.2% 17.1% < 0.001 CAD 40.2% 20.2% < 0.001 Peripheral vascular disease 7.5% 4.1% < 0.001 COPD 28.5% 21.2% < 0.001 Renal failure 42.6% 24.7% < 0.001 Coagulopathy 32% 32.5% 0.01 Obesity 39.3% 36.3% < 0.001 Drug abuse 1.5% 2.5% < 0.001 Alcohol abuse 2.3% 3.9% < 0.001 Smoking 30.5% 32.1% < 0.001 Admission Type, % < 0.001 Emergent 90.3% 86.8% Elective 9.7% 13.2% Insurance type, % < 0.001 Medicare 75.2% 53.6% Medicaid 5.4% 13% Private 16.4% 27.8% Other 3% 5.5% Location/Teaching status of the hospital, % < 0.001 Rural 7.7% 7.6% Urban nonteaching 19.5% 18.1% Urban teaching 72.8% 74.3% Propensity-Matched Outcomes NASH with AfibN=62175 NASH without AfibN= 62190 p-value In-hospital mortality, % 6.5% 4.1% < 0.001 Mortality adjusted odds ratio 1.63 (1.55 – 1.71) < 0.001 Length of stay, in days (mean ± SD) 6.8 ± 7.5 5.9 ± 6.3 < 0.001 Total hospitalization cost, in US $ (mean ± SD) 18701 ± 28527 16220 ± 26589 < 0.001 Disposition, % < 0.001 Discharge to home 40.3% 45.3% Transfer other: includes Skilled Nursing Facility, Intermediate Care Facility, or another type of facility 26.5% 23.6% Home health care 23% 23.7% Against medical advice 0.4% 0.4% *Abbreviations (NASH - Non-alcoholic steatohepatitis, Afib - Atrial Fibrillation, SD - Standard deviation, CAD - Coronary artery disease, COPD - Chronic obstructive pulmonary disease).