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Atrial Fibrillation is a Risk Factor for Worse Outcomes in Patients with End-Stage Liver Disease

Background: Liver disease is a risk factor for development of atrial fibrillation (AF). We aim to study inpatient mortality and resource utilization of end-stage liver disease (ESLD) patients with AF from a nationally representative United States population sample. Methods: For the purpose of our study, we utilized data from National Inpatient Sample for calendar years 2005-2015. Patients with ESLD and AF were identified using relevant International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Key outcomes of inpatient mortality and resource utilization were assessed. We also constructed a multiple logistic regression model to determine predictors of mortality in ESLD patients. Propensity matching was also done to balance confounding variables. Results: A total of 309,959 ESLD patients were included in final analysis. Out of these, about 32,858 (10.6%) patients have concomitant AF. ESLD patients with AF were older and had higher burden of key co-morbidities such as heart failure, diabetes and hypertension. Mortality was significantly higher in both unmatched (12.3% vs. 9.2%, p < 0.01) and matched cohorts (12.2% vs. 10.8%, p < 0.01). Additionally, ESLD patients with AF have longer length of stay, increased facility discharge and cost of hospitalization compared to ESLD patients without AF. In multivariate analysis, AF is an independent predictor of mortality in ESLD patients. Conclusion: AF portends worse outcomes in patients with ESLD. Strong index of suspicion is warranted to timely identify AF in this patient population.

Credits: Muhammad Zia Khan, Muhammad U. Khan, Safi U. Khan, Anas Alharbi, Mohammed Osman, Pratik Agrawal, Mina M. Benjamin, Kinjan Patel, Sudarshan Balla, Muhammad Bilal Munir

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Introduction to AFib
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