TY - JOUR
T1 - Drivers of hospitalization for patients with atrial fibrillation
T2 - Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)
AU - Steinberg, Benjamin A.
AU - Kim, Sunghee
AU - Fonarow, Gregg C.
AU - Thomas, Laine
AU - Ansell, Jack
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Gersh, Bernard J.
AU - Hylek, Elaine
AU - Naccarelli, Gerald
AU - Go, Alan S.
AU - Reiffel, James
AU - Chang, Paul
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
N1 - Funding Information:
S. Kim, L. Thomas, B.J. Gersh have nothing to disclose. Other authors' disclosure information is as follows: B.A. Steinberg, other, modest: Medtronic, Inc. G.C. Fonarow, consultant/advisory board, modest: Ortho. J. Ansell, consultant/advisory board, modest: Boehringer Ingelheim, Alere, Bristol Myers Squibb, Pfizer, Janssen, and Daiichi. P.R. Kowey, consultant/advisory board (modest): Johnson & Johnson, Daiichi Sankyo, Sanofi, Boehringer Ingelheim, Merck, Bristol Myers Squibb, and Portola. K.W. Mahaffey, financial disclosures prior to August 1, 2013, can be viewed at https://www.dcri.org/about-us/conflict-of-interest/Mahaffey-COI_2011-2013.pdf; disclosures after August 1, 2013, can be viewed at http://med.stanford.edu/profiles/kenneth_mahaffey . E. Hylek, honoraria, modest: Boehringer-Ingelheim, Bayer, and consultant/advisory board, modest: Daiichi Sankyo, Ortho-McNeil-Janssen, Johnson & Johnson, Boehringer-Ingelheim, Bristol-Myers Squibb, and Pfizer G. Naccarelli, Consultant: Significant - Janssen, Pfizer, Bristol Myers Squibb, Boehringer Ingelheim, Sanofi, Glaxo Smith Kline, Modest - Xention, Otsuka, Daiichi Sankyo. J. Reiffel, received consultant fees from Medtronic, Merck, Boehringer Ingelheim, Sanofi, Gilead, Xention Discovery and speakers bureau from Boehringer Ingelheim, Sanofi, Janssen, BMS, Pfizer and also received research grant from Gilead, Medtronic and Janssen. P. Chang, employment, significant: Janssen Pharmaceuticals, Inc. E.D. Peterson, research grant, significant: American Heart Association, American College of Cardiology, Janssen Pharmaceutical Products, Eli Lilly & Company, and Society of Thoracic Surgeons; consultant/advisory board, modest: Merck & Co; consultant/advisory board, significant: Boehringer Ingelheim, Genentech, Sanofi-Aventis, and Janssen Pharmaceutical Products. J.P. Piccini, research grant, significant: Johnson & Johnson/Janssen Pharmaceuticals, and Boston Scientific Corporation; other research support, significant: Johnson & Johnson/Janssen Pharmaceuticals; consultant/advisory board, modest: Forest Laboratories, Inc and Medtronic Inc; and consultant/advisory board, significant: Johnson & Johnson/Janssen Pharmaceuticals.
Funding Information:
The ORBIT-AF registry is sponsored by Janssen Scientific Affairs, LLC, Raritan, NJ. Dr Steinberg was funded by NIH T-32 (Training Grant No. 5 T32 HL 7101-38 ).
PY - 2014/5
Y1 - 2014/5
N2 - Background Atrial fibrillation (AF) is the most common cardiac dysrhythmia and contributes significantly to health care expenditures. We sought to assess the frequency and predictors of hospitalization in patients with AF. Methods The ORBIT-AF registry is a prospective, observational study of outpatients with AF enrolled from June 29, 2010, to August 9, 2011. The current analysis included 9,484 participants with 1-year follow-up. Multivariable, logistic regression was used to identify baseline characteristics that were associated with first cause-specific hospitalization. Results Overall, 31% of patients with AF studied (n = 2,963) had 1 or more hospitalizations per year and 10% (n = 983) had 2 or more. The most common hospitalization cause was cardiovascular (20 per 100 patient-years vs 3.3 bleeding vs 17 noncardiovascular, nonbleeding). Compared with those not hospitalized, hospitalized patients were more likely to have concomitant heart failure (42% vs 28%, P <0001), higher mean CHADS 2 (1 point for congestive heart failure, hypertension, age ≥75, or diabetes; 2 points for prior stroke or transient ischemic attack) scores (2.5 vs 2.2, P <0001), and more symptoms (baseline European Heart Rhythm Association class severe symptoms 18% vs 13%, P <0001). In multivariable analysis, heart failure (adjusted hazard ratio [HR] 1.57 for New York Heart Association III/IV vs none, P <0001), heart rate at baseline (adjusted HR 1.11 per 10-beats/min increase >66, P <0001), and AF symptom class (adjusted HR 1.37 for European Heart Rhythm Association severe vs none, P <0001) were the major predictors of incident hospitalization. Conclusions Hospitalization is common in outpatients with AF and is independently predicted by heart failure and AF symptoms. Improved symptom control, rate control, and comorbid condition management should be evaluated as strategies to reduce health care use in these patients.
AB - Background Atrial fibrillation (AF) is the most common cardiac dysrhythmia and contributes significantly to health care expenditures. We sought to assess the frequency and predictors of hospitalization in patients with AF. Methods The ORBIT-AF registry is a prospective, observational study of outpatients with AF enrolled from June 29, 2010, to August 9, 2011. The current analysis included 9,484 participants with 1-year follow-up. Multivariable, logistic regression was used to identify baseline characteristics that were associated with first cause-specific hospitalization. Results Overall, 31% of patients with AF studied (n = 2,963) had 1 or more hospitalizations per year and 10% (n = 983) had 2 or more. The most common hospitalization cause was cardiovascular (20 per 100 patient-years vs 3.3 bleeding vs 17 noncardiovascular, nonbleeding). Compared with those not hospitalized, hospitalized patients were more likely to have concomitant heart failure (42% vs 28%, P <0001), higher mean CHADS 2 (1 point for congestive heart failure, hypertension, age ≥75, or diabetes; 2 points for prior stroke or transient ischemic attack) scores (2.5 vs 2.2, P <0001), and more symptoms (baseline European Heart Rhythm Association class severe symptoms 18% vs 13%, P <0001). In multivariable analysis, heart failure (adjusted hazard ratio [HR] 1.57 for New York Heart Association III/IV vs none, P <0001), heart rate at baseline (adjusted HR 1.11 per 10-beats/min increase >66, P <0001), and AF symptom class (adjusted HR 1.37 for European Heart Rhythm Association severe vs none, P <0001) were the major predictors of incident hospitalization. Conclusions Hospitalization is common in outpatients with AF and is independently predicted by heart failure and AF symptoms. Improved symptom control, rate control, and comorbid condition management should be evaluated as strategies to reduce health care use in these patients.
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U2 - 10.1016/j.ahj.2014.02.003
DO - 10.1016/j.ahj.2014.02.003
M3 - Article
C2 - 24766985
AN - SCOPUS:84899577960
VL - 167
SP - 735-742.e2
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 5
ER -