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. 2020 Sep 11;4(3):e211-e217.
doi: 10.1055/s-0040-1716549. eCollection 2020 Jul.

Burden-of-Illness Associated with Bleeding-Related Hospitalizations in Atrial Fibrillation Patients: Findings from the Nationwide Readmission Database

Benjamin Miao  1   2 , Monique Miller  1 , Belinda Lovelace  3 , Anne Beaubrun  3 , Kelly McNeil-Posey  3 , Mark J Alberts  4 , William Frank Peacock  5 , Olivia S Costa  1   2 , Charles Michael White  1   2 , Craig I Coleman  1   2
Affiliations

Burden-of-Illness Associated with Bleeding-Related Hospitalizations in Atrial Fibrillation Patients: Findings from the Nationwide Readmission Database

Benjamin Miao et al. TH Open. .

Abstract

Introduction A paucity of contemporary data examining bleeding-related hospitalization outcomes in atrial fibrillation (AF) patients exists. Methods Adults in the Nationwide Readmissions Database (January 2016-November 2016) with AF and hospitalized for intracranial hemorrhage (ICH), gastrointestinal, genitourinary, or other bleeding were identified. Association between bleed types and outcomes were assessed using multivariable regression (gastrointestinal defined as referent) and reported as crude incidences and adjusted odds ratios (ORs) or mean differences with 95% confidence intervals (CIs). Results In total, 196,878 index bleeding-related hospitalizations were identified in this AF cohort (CHA2DS2VASc score ≥2 in 95.1%), with 70.8% classified as gastrointestinal. The overall incidences of in-hospital mortality, need for post-discharge out-of-home care, and 30-day readmission were 4.9, 50.8, and 18.2%, respectively. Multivariable regression suggested traumatic and nontraumatic ICHs were associated with higher odds of in-hospital mortality (OR = 3.99, 95% CI = 3.79, 4.19; OR = 13.09, 95% CI = 12.24, 13.99) and need for post-discharge out-of-home care (OR = 2.92, 95% CI = 2.83, 3.01; OR = 2.74, 95% CI = 2.59, 2.90), and increases in mean index hospitalization length-of-stay (8.31 days, 95% CI = 8.03, 8.60, 6.27 days, 95% CI = 5.97, 6.57) versus gastrointestinal bleeding. Genitourinary and other bleeds were associated with lower mortality (OR = 0.37, 95% CI = 0.25, 0.55; OR = 0.59, 95% CI = 0.53, 0.64) and reduced length-of-stays (-2.84 days, 95% CI = - 2.91, -2.76; -2.06 days, 95% CI = - 2.11, -2.01) versus gastrointestinal bleeding. Genitourinary bleeds were also associated with a reduced need for post-discharge out-of-home care (OR = 0.86, 95% CI = 0.77, 0.97). Conclusion The burden of bleeding-related hospitalizations was notably driven by relatively rare but severe and life-threatening ICH, and less morbid but more frequent gastrointestinal bleeding. There is need for continued research on bleeding risk factors and mitigation techniques to avoid bleeding-related patient hospitalizations.

Keywords: atrial fibrillation; bleeding; burden-of-illness; hemorrhage; outcomes.

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Conflict of interest statement

Conflict of Interest C.I.C. has received research funding and honoraria from Portola Pharmaceuticals, Inc., Bayer AG, and Janssen Scientific Affairs LLC. M.J.A. reports consultancy or speaker fees and honoraria from Genentech, Janssen Pharmaceuticals, Boehringer Ingelheim (modest), Pfizer, Bristol-Myers Squibb, Medscape, Portola, and patents/royalties from Duke University. B.L., A.B., and K.M.P. are employees of Portola Pharmaceuticals. W.F.P. has received grants and consulting fees from Abbott, Alere, Banyan, Cardiorentis, Janssen, Portola, Pfizer, Roche, and ZS Pharma; Beckman, Boehringer-Ingelheim, Instrument Labs, Phillips, Prevencio, Singulex and The Medicine's Company, and also has ownership interests at the Comprehensive Research Associate LLC, Emergencies in Medicine LLC. B.M., M.M., O.S.C., and C.M.W. declare they have no conflict of interest.

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Flow diagram of patient selection.
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