Clinical InvestigationElectrophysiologyDrivers of hospitalization for patients with atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)
Section snippets
Methods
We used data from the ORBIT-AF study to assess hospitalization burden in patients with AF. The ORBIT-AF study is a registry of US outpatients with AF, managed by primary care physicians, cardiologists, and/or electrophysiologists. An adaptive design was used to recruit a nationally representative sample of sites, with heterogeneity of geography and provider type. Site management and study coordination were performed by the Duke Clinical Research Institute. Sites enrolled consecutive patients,
Results
The overall ORBIT-AF population included 10,132 patients from 174 sites. After excluding 648 patients who did not have 6- or 12-month follow-up, this yielded a study population of 9,484 patients from 174 sites, enrolled from June 29, 2010, to August 9, 2011. During the follow-up period, these patients experienced a total of 4,548 hospitalizations; 69% had no hospitalization, 21% had exactly 1 hospitalization, and 10.4% had 2 or more hospitalizations during the follow-up period (Figure 1).
Discussion
In this observational cohort of nearly 10,000 outpatients with AF, hospitalization is common, with nearly 1 in 3 patients hospitalized within a year. Most hospitalizations in patients with AF are for cardiovascular causes. Bleeding hospitalizations represented a significant minority, and patients experiencing any hospitalization had lower TTR than did those not hospitalized. Patients with highly symptomatic AF and heart failure are at particular risk for hospitalization, and in multivariable
Limitations
The data for this analysis are derived from an observational cohort of patients in clinical practice with known AF and thus subject to the limitations inherent therein, including sampling and/or reporting biases. Furthermore, conclusions regarding hospitalization cause are limited in that the broad categories are investigator assigned and data regarding urgency of admission (elective, emergent) are not available. Residual measured or unmeasured confounding may influence some or all of these
Conclusions
Hospitalization is common in outpatients with AF, typically for cardiovascular or noncardiovascular, nonbleeding causes. Patients experiencing hospitalization have more comorbid disease, worse AF symptoms, and lower TTR. Heart failure symptom class and AF symptom class, independently, are significant predictors of hospitalization. Improved symptom control and heart failure/comorbid condition management should be targeted as the primary strategies to reduce health care use in these patients.
Dislosures
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).
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.
References (23)
- et al.
Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States
Value Health
(2006) - et al.
Rates and implications for hospitalization of patients >/=65 years of age with atrial fibrillation/flutter
Am J Cardiol
(2012) - et al.
Heart failure-related hospitalization in the U.S., 1979 to 2004
J Am Coll Cardiol
(2008) - et al.
Left atrial volume as an index of left atrial size: a population-based study
J Am Coll Cardiol
(2003) - et al.
Warfarin treatment in patients with atrial fibrillation: observing outcomes associated with varying levels of INR control
Thromb Res
(2009) - et al.
Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study
JAMA
(2001) - et al.
Atrial fibrillation as an independent risk factor for stroke: the Framingham Study
Stroke
(1991) - et al.
Impact of atrial fibrillation on the risk of death: the Framingham Heart Study
Circulation
(1998) - et al.
Economic burden and co-morbidities of atrial fibrillation in a privately insured population
Curr Med Res Opin
(2005) - et al.
The increasing burden of atrial fibrillation compared with heart failure and myocardial infarction: a 15-year study of all hospitalizations in Australia
Arch Intern Med
(2012)
Cardiovascular and non-cardiovascular hospital admissions associated with atrial fibrillation: a Danish nationwide, retrospective cohort study
BMJ Open
Cited by (115)
Heart Rate at Rest and Incident Atrial Fibrillation in Patients With Diastolic Dysfunction
2024, American Journal of CardiologyRhythm versus rate control in patients with newly diagnosed atrial fibrillation – Observations from the GARFIELD-AF registry
2023, IJC Heart and VasculatureAntithrombotiques oraux et pronostic après un an des patients atteints de fibrillation auriculaire dans un milieu à ressources limitées
2023, Annales de Cardiologie et d'AngeiologieAtrial fibrillation in severe aortic stenosis: Prognostic value and results of aortic valve replacement
2023, Journal of Thoracic and Cardiovascular Surgery
Gust H. Bardy, MD, served as guest editor for this article.
Trial Registration clinicaltrials.gov Identifier: NCT01165710.
- m
On behalf of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators Patients.