Incidence of All-Cause, Cardiovascular, and Atrial Fibrillation-Related Hospitalizations

• Published in: JACC. Advances (Online) Vol. 3; no. 8; p. 101117
• Main Authors: Menichelli, Danilo, Pignatelli, Pasquale, Brogi, Tommaso, Pannunzio, Arianna, Violi, Francesco, Lip, Gregory Y.H., Pastori, Daniele, Di Stefano, Tiziana, Sabbatini, Elio, Iannucci, Patrizia, Befani, Alberto, Palumbo, Ilaria Maria, Valeriani, Emanuele
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.08.2024; Elsevier
• Subjects: amiodarone; antiarrhythmic; atrial fibrillation; digoxin; flecainide; hospitalization; hospitalization; AF; antiarrhythmic; flecainide; digoxin; DOAC; VKA; ARB; atrial fibrillation; amiodarone; ACEI; HF; COPD
• ISSN: 2772-963X; 2772-963X
• DOI: 10.1016/j.jacadv.2024.101117

Atrial fibrillation (AF) is associated with an increased risk of hospital admission, but few data on reasons for hospitalization and on the role of anti-arrhythmic drugs are available. The purpose of this study was to investigate the incidence rate and factors associated with all-cause, cardiovascular, and AF-related hospitalizations. Prospective ongoing ATHERO-AF (Atherosclerosis in Atrial Fibrillation) cohort study enrolling AF patients on oral anticoagulants. Primary endpoints were all-cause, cardiovascular, and AF-related hospitalization, the latter defined as AF recurrences for paroxysmal AF and high-rate symptomatic AF episodes for persistent/permanent AF patients. 2,782 patients were included (43.5% female; mean age was 74.6 ± 9.1 years). During a mean follow-up of 31 ± 26.8 months, 1,205 (12.1%/year) all-cause, 533 cardiac (5.7%/year), and 180 (2.0%/year) AF-related hospitalizations occurred. Predictors of AF-related hospitalizations were the use of flecainide/propafenone in both paroxysmal and persistent/permanent AF patients (HR: 1.861; 95% CI: 1.116 to 3.101 and 1.947; 95% CI: 1.069 to 3.548, respectively). Amiodarone (HR: 3.012; 95% CI: 1.835-4.943), verapamil/diltiazem (HR: 2.067; 95% CI: 1.117-3.825), and cancer (HR: 1.802; 95% CI: 1.057-3.070) but not beta-blockers and digoxin were associated with an increased risk of AF-related hospitalizations in persistent/permanent AF patients. Elderly AF patients frequently undergo hospitalizations for both cardiovascular and noncardiovascular causes. The use of anti-arrhythmic drugs was associated with an increased risk of AF-related hospitalization suggesting a scarce effect of these drugs in preventing AF episodes. Therefore, their use should be carefully considered and reserved for symptomatic patients with frequent AF recurrences. [Display omitted]