Burden of comorbid conditions and hospital outcomes in sickle cell trait patients with atrial fibrillation: A retrospective nationwide analysis

Abstract Background: Sickle cell trait (SCT) is linked to worse cardiovascular and renal outcomes. Increased prevalence of atrial fibrillation (AF) is documented in sickle cell trait. Recent studies show an association of SCT with AF, but data on characteristics are lacking. We explore hospitalization trends in patients with both Afib and SCT. Methods: This retrospective study analyzed National Inpatient Sample (NIS) data from 2016 to 2021, where patients (≥18 years) admitted with AF and a history of SCT were included. The cohort was divided into patients with atrial fibrillation with sickle cell trait and without sickle cell trait. Baseline characteristics and comorbidities were assessed using STATA. Multivariate logistic and linear regression analyses were performed. Results: 2170664 hospitalizations with atrial fibrillation were identified. Patients with sickle cell trait were younger (56.98 vs. 70.93, p < 0.001), likely female (65.24%, p = 0.0003), and predominantly Black (90.62%, p < 0.001). The primary outcome of mortality was significantly higher in the SCT group, with an adjusted odds ratio (OR) of 1.72 (95% CI: 1.59 - 1.86, p < 0.001). Comorbid conditions such as congestive heart failure (OR: 2.17, p < 0.001) and cerebrovascular disease (OR: 2.09, p < 0.001) were strong predictors of mortality. Acute myocardial ischemia also increased the odds of mortality (OR: 1.72, p < 0.001), while peripheral vascular disease was not a significant predictor. Secondary outcomes revealed that patients with SCT had longer hospital stays and higher hospital costs. The presence of SCT was associated with an additional 0.10 days of hospitalization (p < 0.001), while CHF and CVD contributed to longer stays (1.45 and 1.01 additional days, respectively, p < 0.001). SCT was also linked to an increase in total hospital charges by $2,017 (p < 0.001), with CHF and CVD further increasing costs by $11,387 and $13,108, respectively. Conclusion: SCT is associated with increased mortality in patients with atrial fibrillation, along with longer hospital stays and higher healthcare costs. These findings highlight the need for targeted risk stratification and tailored management strategies for high-risk populations with SCT and AF. The results also emphasize the need to reassess the clinical significance of SCT beyond an asymptomatic carrier state and understand the associated health consequences.