Frequency, Trends and Outcomes of Cerebrovascular Events Associated with Atrial Fibrillation Hospitalizations.

The main objective is to estimate the frequency, temporal trends, and outcomes of cerebrovascular events associated with AF hospitalization in the United States using the National Inpatient Sample (NIS) dataset. The NIS data was utilized to identify hospitalizations with a primary or secondary diagnosis of AF from January 1, 2005 through September 31, 2015 for the present analysis. Jonckheere-Terpstra Trend was utilized to analyze trends from 2005 to 2015. Global Wald score was used to assess relative contributions of various covariates towards stroke among AF hospitalizations. Between the years 2005 to 2015, there were 36,457,323 (95.2%) AF hospitalizations without cerebrovascular events and 1,824,608 (4.8%) with cerebrovascular events included in the final analysis. There was a statistically significant increase in the proportion of overall stroke, AIS, and AHS (Ptrend value <0.001) per 1000 AF hospitalizations. The frequency of stroke per 1000 AF hospitalizations was highest among patients with CHA2DS2VASc score≥ 3 and Charlson's comorbidity index≥3. The trend of in-hospital mortality decreased during the study period, however, it remained higher in those with cerebrovascular events compared to those without. Lastly, hypertension, advancing age, and chronic lung disease were major stroke predicting factors among AF hospitalizations. These cerebrovascular events were associated with longer length of stay and higher costs. In conclusion, the incidence of cerebrovascular events associated with AF hospitalizations remained significantly high and the trend continues to ascend despite technological advancements. Strategies should improve to reduce the risk of AF-related stroke in the United States.