Atrial Fibrillation in young patients: Insights from the National Inpatient Sample

Abstract Background The burden of atrial fibrillation (AF) in young patients is not well characterized. We aimed to study trends in AF burden and management over time in patients aged 18-45 years. Methods We conducted a retrospective analysis of all primary AF hospitalizations in patients 18-45 years of age using the United States National Inpatient Sample (NIS) data from 01/01/2008 to 12/31/2019. We collected data on clinical and socioeconomic features including demographics, comorbidities, ZIP Code income, resource utilization, and various clinical outcomes. Quartile classification of the median household income of the zip code of the patient’s residence was used to classify socioeconomic status. Results The rate of AF hospitalizations decreased over time from 18.7 per 100,000 in 2008 to 13.0 per 100,000 in 2019 (p<0.001) (Figure 1). AF hospitalizations were higher amongst males compared to females (24.0 vs. 7.5 per 100,000), and higher in black patients compared to other ethnicities (20.4 for black vs. 15.6 for white vs. 8.5 Hispanic per 100,000) (Figure 2). The utilization of electrical cardioversion increased from 17.6% in 2008 to 21.9% in 2019 (p<0.001), and the utilization of catheter ablation decreased from 7.1% in 2008 to 4.3% in 2019 (p<0.001) (Figure 1). Men were more likely to undergo electrical cardioversion than women (20.1% vs. 14.8%, p <0.001). White patients were more likely to undergo electrical cardioversion (20.8% vs. 14.3%) and catheter ablation (6.1% vs. 3.3%, p <0.001) compared to black patients. Patients in the highest socioeconomic status quartile were more likely to undergo electrical cardioversion (21.9% vs. 16.4%, p<0.001) and catheter ablation (8.0% vs. 3.7%, p<0.001) compared to patients in the lowest socioeconomic status quartile. Conclusions We found significant differences in inpatient AF burden across different patient populations. We identified differences in inpatient AF management based on sex, ethnicity, and socioeconomic status. Further research is needed to better understand these differences, their impact on clinical outcomes, and strategies to improve healthcare disparities.