Burden of dementia in atrial fibrillation hospitalizations- analysis of national inpatient sample 2016-2018

Type of funding sources: None.

Atrial fibrillation is a common disorder in the elderly population and a known risk factor for stroke and dementia.

 To study the burden of dementia in Afib hospitalizations and identify the predictors of in-hospital mortality in Afib with dementia hospitalizations.

We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of Afib. Hospitalizations of Afib with dementia was compared with Afib without dementia. We used the Chi-square test for differences between categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders.

 We identified 1,236,540 weighted Afib hospitalizations across three years. Of which, 79,405 (6.4%) of them were associated with dementia. Afib with dementia hospitalizations were associated with older age (mean age 83.2 vs 70.0 yrs; P < 0.01), higher rate of chronic Afib (15.3% vs 7.5%; P < 0.01), higher rate of comorbidity (% of >3 Elixhauser comorbidity score 91.8% vs 83.6%; P < 0.01). After adjusting for patient and hospital-level characteristics, we observed that Afib with dementia hospitalizations was associated with higher odds of in-hospital mortality compared to Afib without dementia [Odds Ratio (OR): 1.6 (1.4 – 1.9); P < 0.01]. We also observed statistically significant association with increased LOS [4.7 vs 3.2 days; P < 0.01], repeated falls [OR: 2.8 (2.5 – 3.1); P < 0.01] and protein calorie malnutrition [OR: 1.9 (1.7 – 2.0); P < 0.01] in Afib with dementia group.

Afib with dementia hospitalizations are not only associated with higher mortality, but they are also associated with higher repeated fall rates, and skilled nursing facility discharge dispositions. Co-morbidities like hypertension, CKD, obesity, HFrEF, HFpEF, OSA are associated with higher in-hospital mortality. Our study findings emphasize the burden of dementia in Afib hospitalizations and the need for prevention of poor outcomes in this population.