title: Increased risk of stroke and mortality following new-onset atrial fibrillation during hospitalization.
abstract: OBJECTIVE
  The outcome of patients who develop new-onset atrial fibrillation (AF) during hospitalization is unknown, and the management of this patient population is not specifically addressed by current guidelines. We investigated the incidence of death and inhospital stroke among a large cohort of hospitalized inpatients who developed new-onset AF.
  
  
  RESULTS
  All patients ≥50 years of age admitted to a tertiary academic medical centre (20 April 2005 to 31 December 2011; n = 84 919) were studied. Demographic variables were compared among patients categorized as having new-onset, pre-existing, or no AF. A propensity-matched analysis was employed to compare outcomes by generalized estimating equations. Primary endpoints were all-cause 30-day and 1-year mortality and inhospital stroke. New-onset AF occurred in 1749 (2.1%) hospitalized patients. Among patients with new-onset AF, mortality at 30 days and 1 year was higher compared with patients without AF (at 30 days: OR 2.28, 95% CI 1.72-3.02, P < 0.0001; at 1 year: RR 1.53, 95% CI 1.36-1.73, P < 0.0001), and compared with patients with pre-existing AF at 30 days (OR 1.52, 95% CI 1.06-2.17, P = 0.02) -an effect that persisted as non-significant trend at 1 year (RR 1.14, 95% CI 0.98-1.34, P = 0.09). Risk of inhospital stroke was higher in patients with new-onset AF compared with patients without AF (OR 4.53, 95% CI 1.36-15.11, P = 0.02). Among patients with new-onset AF, the CHA2DS2-Vasc score correlated with incidence of inhospital stroke.
  
  
  CONCLUSIONS
  New-onset AF among hospitalized inpatients is independently associated with an increased incidence of stroke and mortality.
authors.affiliation: Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Massera
authors.affiliation: Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Vorchheimer
authors.affiliation: Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
authors.forename: Abdissa
authors.initials: A
authors.lastname: Negassa
authors.affiliation: Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: Atrial fibrillation; Hospitalization; Mortality; Stroke