Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Mortality and morbidity in patients with atrial fibrillation and liver cirrhosis
Yousef H Darrat, Aiman Smer, Claude-Samy Elayi, Gustavo X Morales, Fahad Alqahtani, Mohamad Alkhouli, John Catanzaro, Jignesh Shah, Mohsin Salih
Yousef H Darrat, Department of Internal Medicine, Veterans Affairs Medical Center, Lexington, KY 40515, United States
Aiman Smer, Department of Internal Medicine, Creighton University, Omaha, NE 68178, United States
Claude-Samy Elayi, John Catanzaro, Department of Internal Medicine, University of Florida, Jacksonville, FL 32211, United States
Gustavo X Morales, Cardiac Electrophysiology, Grandview Medical Center, Birmingham, AL 35243, United States
Fahad Alqahtani, Department of Internal Medicine, University of Kentucky, Lexington, KY 40536, United States
Mohamad Alkhouli, Department of Internal Medicine, West Virginia University, Morgantown, WV 26506, United States
Jignesh Shah, Cardiac Electrophysiology, Boulder Heart, Boulder, CO 80303, United States
Mohsin Salih, Department of Internal Medicine, University of Southern Illinois, Springfield, IL 62702, United States
Author contributions: Salih M designed the research; Darrat YH, Elayi CS, and Morales GX wrote the paper; Smer A, Catanzaro J, and Shah J performed research; Alqahtani F and Alkhouli M analyzed the data; all authors contributed to this paper.
Institutional review board statement: The National (Nationwide) Inpatient Sample is a large publicly available all-payer inpatient care database in the United States. Since it is publicly available and patient data is de-identified, an institutional review board approval was not required.
Informed consent statement: The National (Nationwide) Inpatient Sample is a large publicly available all-payer inpatient care database in the United States. Since it is publicly available and there was no patient interaction, informed consent was not obtained.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yousef H Darrat, MD, Attending Physician, Department of Internal Medicine, Veterans Affairs Medical Center, 1101 Veterans Drive, Lexington, KY 40502, United States. ydarat@hotmail.com
Received: January 30, 2020
Peer-review started: January 30, 2020
First decision: March 24, 2020
Revised: May 10, 2020
Accepted: May 29, 2020
Article in press: May 29, 2020
Published online: July 26, 2020
ARTICLE HIGHLIGHTS
Research background
Atrial fibrillation (AF) is the most common arrhythmia encountered in medical practice and is associated with adverse outcomes. However, the outcomes of AF in the special population of patients with liver cirrhosis have not been well studied and the results of several studies are conflicting.
Research motivation
Mortality rate and clinical outcomes of patients with concomitant AF and liver cirrhosis are an integral aspect of clinical decision and policymaking. Realizing the clinical impact of such disorders in a patient paves the path to design prospective studies.
Research objectives
We aimed to investigate if death is higher in patients with liver cirrhosis who have AF and to also assess outcomes during hospitalization. Understanding the outcomes will assist future research in designing prospective studies and randomized trials to improve morbidity and mortality.
Research methods
In this study, we examined outcomes of patients with concomitant AF and liver cirrhosis from the National Inpatient Sample database, the largest publicly available inpatient healthcare resource in the United States. We investigated inpatient mortality rate as a primary outcome. Secondary outcomes included cerebral vascular accidents, transient ischemic attack, acute kidney injury, blood transfusion, gastrointestinal bleeding, length of stay, hospital charges, and discharge disposition.
Research results
Inpatient mortality was found to be higher in patients with concomitant AF and liver cirrhosis compared to patients without the arrhythmia. We also found that it was associated with higher rates of stroke and acute kidney injury, and prolonged hospitalization.
Research conclusions
AF is an adverse prognostic indicator in inpatients with liver cirrhosis. It is associated with increased rates of death, stroke, and acute kidney injury but interestingly less gastrointestinal bleeding and need for blood transfusion. Also, it is associated with prolonged hospitalization and increased cost.
Research perspectives
Future studies are needed to prospectively investigate the impact of the arrhythmia in liver cirrhosis.
