Contemporary trends of hospitalization for atrial fibrillation in the United States, 2000 through 2010: implications for healthcare planning.
BACKGROUND
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The associated morbidity and mortality make AF a major public health burden. Hospitalizations account for the majority of the economic cost burden associated with AF. The main objective of this study is to examine the trends of AF-related hospitalizations in the United States and to compare patient characteristics, outcomes, and comorbid diagnoses.


RESULTS
With the use of the Nationwide Inpatient Sample from 2000 through 2010, we identified AF-related hospitalizations using International Classification of Diseases, 9th Revision, Clinical Modification code 427.31 as the principal discharge diagnosis. Overall AF hospitalizations increased by 23% from 2000 to 2010, particularly in patients ≥65 years of age. The most frequent coexisting conditions were hypertension (60.0%), diabetes mellitus (21.5%), and chronic pulmonary disease (20.0%). Overall in-hospital mortality was 1%. The mortality rate was highest in the group of patients ≥80 years of age (1.9%) and in the group of patients with concomitant heart failure (8.2%). In-hospital mortality rate decreased significantly from 1.2% in 2000 to 0.9% in 2010 (29.2% decrease; P<0.001). Although there was no significant change in mean length of stay, mean cost of AF hospitalization increased significantly from $6410 in 2001 to $8439 in 2010 (24.0% increase; P<0.001).


CONCLUSIONS
Hospitalization rates for AF have increased exponentially among US adults from 2000 to 2010. The proportion of comorbid chronic diseases has also increased significantly. The last decade has witnessed an overall decline in hospital mortality; however, the hospitalization cost has significantly increased.
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.). dr.nilesh.j.patel@gmail.com.
Nileshkumar J
NJ
Patel
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Abhishek
A
Deshmukh
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Sadip
S
Pant
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Vikas
V
Singh
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Nilay
N
Patel
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Shilpkumar
S
Arora
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Neeraj
N
Shah
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Ankit
A
Chothani
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Ghanshyambhai T
GT
Savani
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Kathan
K
Mehta
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Valay
V
Parikh
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Ankit
A
Rathod
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Apurva O
AO
Badheka
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
James
J
Lafferty
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Marcin
M
Kowalski
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Jawahar L
JL
Mehta
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Raul D
RD
Mitrani
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Juan F
JF
Viles-Gonzalez
From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
Hakan
H
Paydak
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006285:Health Planning; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D055815:Young Adult
atrial fibrillation; cost; hospitalization