The Prevalence and Impact of Atrial Fibrillation on Patients with Chronic Total Occlusions: Insights from the National Inpatient Sample

The impact of atrial fibrillation (AF) on patients with chronic total occlusions (CTOs) at the national level remains unclear. In this study, we conducted a retrospective analysis of data from the National Inpatient Sample to assess the characteristics and in-hospital outcomes of patients with CTO based on the presence or absence of AF. Multiple logistic and linear regressions examined factors associated with AF and evaluated its impact on length of stay (LoS), cost, and mortality. The analysis included 480,180 patients diagnosed with CTO, with AF present in 28.0% of cases. Patients with CTOs and AF were older (median age 73 vs. 66 years, <i>p</i> < 0.001) and exhibited lower female representation (25.0% vs. 27.9%, <i>p</i> < 0.001). Factors most strongly associated with AF included previous heart failure (OR 1.98, 95% CI 1.92-2.05, <i>p</i> < 0.001), liver disease (OR 1.37, 95% CI 1.27-1.48, <i>p</i> < 0.001), and obesity (OR 1.25, 95% CI 1.20-1.30, <i>p</i> < 0.001). AF correlated with increased in-hospital mortality (OR 1.29, 95% CI 1.18-1.40, <i>p</i> < 0.001), ischemic stroke (OR 1.27, 95% CI 1.13-1.42, <i>p</i> < 0.001), and major bleeding (OR 1.38, 95% CI 1.30-1.46). Moreover, AF was associated with a longer LoS (coef 1.58, 95% CI 1.50 to 1.67, <i>p</i> < 0.001) and higher in-hospital costs (coef 6.22, 95% CI 5.81 to 6.63, <i>p</i> < 0.001). Patients with CTOs and AF were older and had more underlying health problems compared to patients without AF. The patients with AF have worse outcomes in terms of mortality, ischemic stroke, major bleeding, length of stay, and costs.