National Trends in Atrial Fibrillation Hospitalizations, Readmissions, and Mortality, 2010 to 2022.

BACKGROUND: Atrial fibrillation (AF) is a leading cause for acute cardiovascular hospitalizations. There is limited contemporary data about national trends and risk factors that predict readmission and mortality. OBJECTIVES: The objective of the study was to identify national trends in hospitalizations, readmissions, and inpatient mortality during index admission for AF. METHODS: Using nationally representative, survey-weighted hospitalization data, we assessed AF hospitalization trends and calculated risk factors for 30-day readmission and in-hospital mortality using cluster-adjusted multivariable logistic regression. RESULTS: Between 2010 and 2022, there were 6,141,046 primary AF hospitalizations among 5,528,397 unique patients, of which 892,254 (16.1%) experienced 30-day readmission and 53,084 (0.96%) deaths during index admission. Renal disease was the strongest predictor of both 30-day readmission (adjusted OR: 1.39; 95% CI: 1.37-1.40) and in-hospital mortality (adjusted OR: 3.98; 95% CI: 3.85-4.11); public insurance was also strongly associated with adverse outcomes, including Medicare (readmission OR: 1.46; mortality OR: 1.17) and Medicaid coverage (readmission OR: 1.62; mortality OR: 1.43), along with lower income quartile, chronic obstructive pulmonary disease (readmission OR: 1.48; mortality OR: 1.66), heart failure (readmission OR: 1.38; mortality OR: 1.83), prior myocardial infarction (readmission OR: 1.26; mortality OR: 3.34), and female sex (readmission OR: 1.12; mortality OR: 1.07). Total cost of AF hospitalizations in 2022 was $7.2 billion. CONCLUSIONS: In the United States, AF hospitalizations and readmissions experienced a modest overall net increase from 2010 to 2022, with a notable decline from 2014 to 2020 before rebounding following the COVID-19 pandemic, and 30-day readmissions and in-hospital mortality were associated with age, comorbidities, and socioeconomic factors.