Determinants of Prolonged Length of Hospital Stay of Patients with Atrial Fibrillation

Abstract

Background and Aim: The increasing prevalence and high hospitalization rates make atrial fibrillation (AF) a significant healthcare strain. However, there are limited data regarding the length of hospital stay (LOS) of AF patients. Our purpose was to determine the main drivers of extended LOS of AF patients. Methods: All AF patients, hospitalized consecutively in a tertiary cardiology center, from January 2018 to February 2020 were included in this retrospective cohort study. Readmissions were excluded. Prolonged LOS was defined as more than seven days (the upper limit of the third quartile). Results: Our study included 949 AF patients, 52.9% females. The mean age was 72.5 ± 10.3 years. The median LOS was 4 days. A total of 28.7% had an extended LOS. Further, 82.9% patients had heart failure (HF). In multivariable analysis, the independent predictors of extended LOS were: acute coronary syndromes (ACS) (HR 4.60, 95% CI 1.66–12.69), infections (HR 2.61, 95% CI 1.44–3.23), NT-proBNP > 1986 ng/mL (HR 1.96, 95% CI 1.37–2.82), acute decompensated HF (ADHF) (HR 1.76, 95% CI 1.23–2.51), HF with reduced ejection fraction (HFrEF) (HR 1.69, 95% CI 1.15–2.47) and the HAS-BLED score (HR 1.42, 95% CI 1.14–1.78). Conclusion: ACS, ADHF, HFrEF, increased NT-proBNP levels, infections and elevated HAS-BLED were independent predictors of extended LOS, while specific clinical or therapeutical AF characteristics were not.

Relationship between nutritional status and length of hospital stay among patients with atrial fibrillation – a result of the nutritional status heart study

“…In our sample, the average LOHS in patients with AF was 3.5 days. This result is consistent with the observations of other researchers, where it was 3–4 days ( 24 , 25 ). Unfortunately, nutritional status, especially malnutrition, is often ignored in clinical practice, and many patients with CVD are not properly diagnosed, which can result in a worsened disease course.…”

“…A significantly longer stay was characterized in this study by the group of patients who underwent direct current cardioversion ( 27 ). In the Vijan et al study, independent factors affecting LOHS (≥7 days for this study) included ACS, decompensated HF, increased NT-proBNP levels and infections ( 25 ). Researchers studying nutritional status confirm that malnutrition upon hospital admission is quite common and is associated not only with prolonged hospital stay but also with worse prognosis ( 28 – 31 ).…”

Prognostic Impact of Severe Atrial Functional Tricuspid Regurgitation in Atrial Fibrillation Patients

“…We included all AF patients admitted consecutively to the Cardiology Department, according to the criteria previously published [ 6 ]. Patients with organic TR, significant pulmonary hypertension, left ventricular ejection fraction < 50%, those with implanted cardiac devices [ 17 , 21 ] and those with in-hospital mortality were excluded.…”

“…With a prevalence on the rise due to better survival and ageing of the population, it is estimated that one in 4–6 adults will develop AF during their life [ 4 , 5 ]. Although mortality trends have been decreasing lately, the health and financial burden of AF, its complications and related hospitalizations remains high [ 1 , 6 ]. In anticoagulated AF patients, the most common causes of death were heart failure (HF), infections and cancer, with only 7% of deaths secondary to stroke [ 7 ].…”

The complex interplay between right ventricular dysfunction and atrial fibrillation – a narrative review

“…The hospital admissions of AF patients are mainly prolonged due to the overall cardiovascular burden or AF related complications, and not by AF itself. [5] Thromboembolic complications, particularly stroke, are corelated with high mortality, and the risk of events is increasing with the sum of comorbidities. [6] The established interplay between AF and heart failure (HF) is associated with lower quality of life and significant mortality.…”