Gender differences, outcomes and trends among nonagenarian with atrial fibrillation: insight from National Inpatient Sample database

Dinesh Voruganti; Ghanshyam Shantha; Sushma Dugyala; Alexander Bolton; Ala Mohsen; Subodh Devabhaktuni; Hakan Paydak; Jawahar L Mehta

doi:10.11909/j.issn.1671-5411.2021.02.007

Gender differences, outcomes and trends among nonagenarian with atrial fibrillation: insight from National Inpatient Sample database

J Geriatr Cardiol. 2021 Feb 28;18(2):114-122. doi: 10.11909/j.issn.1671-5411.2021.02.007.

Authors

Dinesh Voruganti¹, Ghanshyam Shantha², Sushma Dugyala³, Alexander Bolton⁴, Ala Mohsen⁵, Subodh Devabhaktuni¹, Hakan Paydak¹, Jawahar L Mehta¹

Affiliations

¹ Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Arkansas, USA.
² Division of Cardiovascular Medicine, Wake Forest Medical Center, North Carolina, USA.
³ Division of Internal Medicine, University of Alabama, Alabama, USA.
⁴ Department of Internal Medicine, Unity Point Health, Iowa, USA.
⁵ Division of Cardiovascular Medicine, Louisiana State University, Louisiana, USA.

PMID: 33747060
PMCID: PMC7940966
DOI: 10.11909/j.issn.1671-5411.2021.02.007

Abstract

Background: Nonagenarians (NG), individuals aged ≥ 90 years, constitute an increasing proportion of hospitalizations presenting with atrial fibrillation (AF). However, not much is known about demographics, clinical outcomes, and trends of hospitalizations. Therefore, we analyzed data about hospitalizations and clinical outcomes among NGs with AF over ten years from 2005 to 2014 using a publically available database, the National Inpatient Sample.

Methods: All hospitalizations and major outcomes of subjects ≥ 90 years with a primary diagnosis of AF (ICD-9-CM code 427.31) over a ten-year period were assessed in this study by multivariate logistic regression analysis.

Results: There were more females than males (176,268 females, 51,384 males) in this analysis. The number of hospitalizations for AF among NG increased by 50% (17,295 in 2005 to 25,830 in 2014). Males were more likely to undergo cardioversion (6.14% of males vs. 5.06% of females, P < 0.0001). Over this period, in-hospital mortality declined from 3.21% in 2005 to 2.38% in 2014 ( P = 0.0041), with higher in-hospital mortality in males (3.23% in males vs. 2.76% in females, P = 0.0138), mean length of hospitalization decreased from 4.53 days to 4.13 days (P < 0.0001), the prevalence of congestive heart failure fell from 0.48% to 0.23% ( P = 0.0257), and the use of anticoagulation increased from 6.09% to 14.54% (P < 0.0001). In a multivariate analysis, hospital admission on the weekend, Elixhauser comorbidity index, CHA ₂DS₂VASc score, acute respiratory failure, and the length of hospital stay were associated with a higher risk of in-hospital mortality.

Conclusions: From 2005 to 2014, AF-related hospitalizations among NGs increased, more so in in females population, mortality trends improved, rates of anticoagulation increased, and cardioversions increased. Despite the decreasing trend of in-hospital mortality since 2005, the relatively high mortality rate in males warrants further studies.

Copyright and License information: Journal of Geriatric Cardiology 2021.