The Impact of Weight Categories on the Association Between Atrial Fibrillation/Flutter and Known Risk Factors: A Nationwide Inpatient Data Analysis

Abstract

Background/Objectives: Atrial fibrillation and atrial flutter (Afib/Aflut) are the most common arrhythmias presenting to the emergency department. The goal of this study was to evaluate any predictor of Afib/flut with cardiovascular risk factors and demographics based on weight categories. Methods: Using ICD-10 codes from the large Nationwide Inpatient Sample (NIS) database in the years 2016-2020, we evaluate any association between the presence of Afib/Aflut with risk factors and demographics in different weight categories in adults over the age of 18. Results: A total of 23,037,013 afib/flut patients were found in the NIS database. Obesity and morbid obesity were independently associated with the presence of Afib/Aflut (for multivariate OR obesity: 1.28, CI 1.27-1.28, p < 0.001; for morbid obesity: OR 1.9, CI 1.89-1.91, p < 0.001). Regardless of weight categories such as cachexia, overweight, obese, or morbidly obese, traditional risk factors remained independently associated with Afib/Aflut. Furthermore, male gender and Caucasians were independently associated with the presence of Afib/Aflut regardless of any weight categories. (For example, in the overweight categories, the multivariate OR for females was 0.69, CI: 0.69-0.69, p < 0.001, and for African Americans, OR 0.62, CI 0.61-0.62, p < 0.001). Conclusions: Traditional risk factors were persistently associated with the occurrence of atrial fibrillation regardless of weight categories. Furthermore, the Caucasian race and male gender were also strong independent predictors of Afib/Aflut.

Keywords: arrhythmia; atrial fibrillation; atrial flutter; morbid obesity; obesity; obesity paradox; risk factors.

Figure 1

(A) mechanism of atrial flutter showing organized re-entry in the right atrium, (B) showing disorganized micro re-entry in the atrial muscle originating mostly from left atrium.

Figure 2

Percent of patients with a diagnosis of atrial fibrillation (Afib) or atrial flutter (Aflut) in each weight category.

Figure 3

The Odds ratio of a diagnosis of atrial fibrillation (Afib) or atrial flutter (Aflut) for known cardiac risk factors and demographics in each weight category, including cachexic (A), overweight (B), obese (C), and morbidly obese (D).