Impact of Atrial Fibrillation on Patients With Inflammatory Bowel Disease Admitted for Colectomy

Abstract

IntroductionInflammatory bowel disease (IBD) is a chronic, relapsing, inflammatory disorder of the gastrointestinal tract. Patients with IBD may undergo a segmental or total colectomy, depending upon the extent of the disease. It is estimated that approximately 20 to 30 percent of patients with advanced ulcerative colitis will eventually require surgical resection. The incidence and prevalence of Atrial Fibrillation (AF) are increasing globally. There is plausible evidence linking inflammation to the initiation and perpetuation of AF. Given the importance of systemic inflammation in the pathogenesis of AF, an increased risk of the development of other diseases related to systemic inflammation can be expected. ObjectiveStudy how AF can affect the outcome of the patients in a population database hospitalized due to IBD flare and in whom colectomy was performed. MethodologyData from the National Inpatient Sample database from 2016 to 2019 were used to obtain baseline demographic numbers and outcome variables. T-tests and chi-square tests were used to compare data. Univariate and multivariate logistic regression was used to calculate Odds ratios for comorbidities. ResultsThe study identified 27,165 patients with IBD who had colectomy during the same admission, among whom 2,045 also had AF. AF patients had a statistically significant longer mean LOS than patients without AF (16.79 vs. 11.24 days, p-value 0.001). AF patients also had significantly higher hospital charges ($222,109 vs. $142,011, p-value < 0.001). The mortality rate in IBD undergoing colectomy patients with AF was higher than in patients without AF (13.45% vs. 2.69%, p-value < 0.001), which was also reflected in multivariate analysis with an odds ratio of 2.27 (p-value < 0.001) after adjusting for age, gender, race, and comorbidities. ConclusionOur study showed that a national cohort of IBD patients with a history of colectomy had increased mortality and morbidity in the presence of AF. A finding that can guide physicians to allocate more time to optimizing the management of AF in this group of patients decreases the risk of complications, length of stay, and overall mortality.

Inflammatory bowel disease and atrial fibrillation: a contemporary overview

“…It was indicated that IBD patients with atrial fibrillation had a longer mean length of stay, greater total hospital charge, and an in-hospital mortality rate after the colectomy. Moreover, they had a greater risk of requiring mechanical ventilation, developing cardiac arrest, and ICU admission [25]. Interestingly, Tilly et al examined the relationship between autoimmune diseases and new-onset atrial fibrillation in a large UK population [28].…”

“…In a more recent study, Mahfouz et al . [25] examined the impact of atrial fibrillation in patients with IBD that underwent colectomy. In this study, the IBD patients with atrial fibrillation were older (71 vs 49 years of age) and they had more comorbidities such as hypertension, diabetes, congestive heart failure, chronic kidney disease, COPD, and coronary artery disease.…”