title: Hospitalizations in patients with atrial fibrillation: an analysis from ROCKET AF.
abstract: OBJECTIVE
  The high costs associated with treatment for atrial fibrillation (AF) are primarily due to hospital care, but there are limited data to understand the reasons for and predictors of hospitalization in patients with AF.
  
  
  RESULTS
  The ROCKET AF trial compared rivaroxaban with warfarin for stroke prophylaxis in AF. We described the frequency of and reasons for hospitalization during study follow-up and utilized Cox proportional hazards models to assess for baseline characteristics associated with all-cause hospitalization. Of 14 171 patients, 14% were hospitalized at least once. Of 2614 total hospitalizations, 41% were cardiovascular including 4% for AF; of the remaining, 12% were for bleeding. Compared with patients not hospitalized, hospitalized patients were older (74 vs. 72 years), and more frequently had diabetes (46 vs. 39%), prior MI (23 vs. 16%), and paroxysmal AF (19 vs. 17%), but less frequently had prior transient ischaemic attack/stroke (49 vs. 56%). After multivariable adjustment, lung disease [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.29-1.66], diabetes [1.22, (1.11-1.34)], prior MI [1.27, (1.13-1.42)], and renal dysfunction [HR 1.07 per 5 unit GFR < 65 mL/min, (1.04-1.10)] were associated with increased hospitalization risk. Treatment assignment was not associated with differential rates of hospitalization.
  
  
  CONCLUSIONS
  Nearly 1 in 7 of the moderate-to-high-risk patients with AF enrolled in this trial was hospitalized within 2 years, and both AF and bleeding were rare causes of hospitalization. Further research is needed to determine whether care pathways directed at comorbid conditions among AF patients could reduce the need for and costs associated with hospitalization.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University School of Medicine, Durham, NC, USA adam.devore@duke.edu.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.affiliation: University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Berkowitz
authors.affiliation: Hospital of the University of Münster, Münster, Germany.
authors.forename: Guenter
authors.initials: G
authors.lastname: Breithardt
authors.affiliation: Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.affiliation: Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia.
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Janssen Research & Development, Raritan, NJ, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Nessel
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.affiliation: University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D015897:Comorbidity; D004311:Double-Blind Method; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005843:Geography; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007391:International Cooperation; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D065427:Factor Xa Inhibitors; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Atrial fibrillation; Hospitalization; Outcomes; Rivaroxaban; Stroke