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

Benjamin Miao; Monique Miller; Belinda Lovelace; Anne Beaubrun; Kelly McNeil-Posey; Mark J Alberts; William Frank Peacock; Olivia S Costa; Charles Michael White; Craig I Coleman

doi:10.1055/s-0040-1716549

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

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

Authors

Benjamin Miao^{1

2}, Monique Miller¹, Belinda Lovelace³, Anne Beaubrun³, Kelly McNeil-Posey³, Mark J Alberts⁴, William Frank Peacock⁵, Olivia S Costa^{1

2}, Charles Michael White^{1

2}, Craig I Coleman^{1

2}

Affiliations

¹ Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, United States.
² Evidence-Based Practice Center, Hartford Hospital, Hartford, Connecticut, United States.
³ Health Economics and Outcomes, Portola Pharmaceuticals, San Francisco, California, United States.
⁴ Department of Neurology, Hartford Hospital, Hartford, Connecticut, United States.
⁵ Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, United States.

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.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).

Grants and funding

Funding Funding was provided by Portola Pharmaceuticals, South San Francisco, California, United States. The funders of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors have approved the final manuscript.