Impact of Co-morbidites on Discharge Outcomes in Patients with Atrial Fibrillation Presenting with Acute Ischemic Stroke: Analysis Based on National Inpatient Sample 2016 - 2019
Muhammad Ayub1, Mohammad Sheikh1, Prabandh Buchhanolla1, Omar Elsekaily1, Saurabh Kataria1, Muhammad Khalid1, Junaid Ansari2, Tooba Aslam3, Walaa Elsekaily4, Himanshu Chokhawala1
1Louisiana State University Health Sciences Center at Shreveport, 2Neurology, The Johns Hopkins Hospital, 3Central Park Medical College Lahore, 4The Medical University of South Carolina
Objective:

Assessing effect of co-morbidities on mortality and discharge outcomes in patients with Atrial fibrillation (AF) presenting with acute ischemic stroke (AIS).

Background:

AF is a major risk factor for AIS and prior studies reveal association of AF with worse outcomes. Here we explore the effect of co-morbidities that may further worsen outcomes in this population.

Design/Methods:

We conducted retrospective analysis on patients in National Inpatient Sample 2016-2019 database with following selection criteria: AIS presentation and extant AF with corresponding ICD10 codes. Patients were grouped based on OACs user vs non-user. Outcome variables include: mortality, discharge disposition using re-coded variables from NIS discharge variables (corresponding to home [ref], another facility, or death), and length of stay in days. All models were adjusted for age, sex, hypertension, obesity, diabetes mellitus (DM), and smoking. Effect of co-morbidities on mortality and discharge disposition was analyzed using binary and multinomial multivariable logistic regression respectively and on length of stay was analyzed using multivariable linear regression.

Results:

Among 183,035 patients (mean age 77.19 years, 52.41% females), DM was associated with increased risk of discharge to a facility (RR: 1.34; 95% CI: 1.31 – 1.37) vs home; and increased length of stay (p < 0.001) when adjusted for all other included factors. Obesity was associated with increased risk of discharge to a facility (RR: 1.068; 95% CI: 1.03 – 1.1); decreased mortality (OR: 0.72; 95% CI: 0.67 – 0.77). Hypertension was associated with increased length of stay (p = 0.025); decreased mortality (OR: 0.69; 95% CI: 0.66 – 0.71); and decreased risk of discharge to a facility (RR: 0.75; 95% CI: 0.74 – 0.77).

Conclusions:

Our results reveal potential association of hypertension with decreased mortality and better discharge disposition while DM significantly increased length of stay and worsened discharge disposition in patients with AF presenting with AIS.