Trends and outcomes associated with atrial fibrillation in patients hospitalised with non-Hodgkin lymphoma - insights from national inpatient sample (NIS) database (2016-2022)

Abstract Background: Non-Hodgkin Lymphoma (NHL) is one of the most widespread malignancies in the United States. It constitutes approximately 4 percent of the total cancer patients. NHL patients are at an immediate risk of developing atrial fibrillation (AF) that can also influence clinical outcomes. Although it is significant, there is insufficient data that demonstrates the temporal patterns and clinical outcomes that accompany AF among patients with NHL. Methods: We performed a retrospective cohort analysis using the National Inpatient Sample (NIS) Database from 2016 to 2022. We identified patients who had a primary diagnosis of NHL using ICD-10-CM codes. The patients were categorized further according to the presence or absence of AF. We compared baseline characteristics, existing comorbidities, in-hospital outcomes, and complications between the two groups. Our main outcome was in-hospital mortality. Other outcomes were length of stay (LOS), total hospital charges, and complication rates between the two groups. We used survey-weighted multivariable logistic and linear regression to adjust for potential confounders. Statistical analysis was done on STATA version 17.0. Results: A total of 260210 patients hospitalized with NHL were identified, of which 17135 (7%) had coexisting AF. Patients with AF were older (mean age 74.8 vs 62.9 years, p<0.0001), more likely to be men, and White. They also showed a greater prevalence of heart failure (32% vs 9%, OR=4.82), hypertension (38% vs 15%, OR=3.47), Diabetes mellitus (12% vs 10%, OR=1.18), dyslipidemia (44% vs 29%, OR=1.85), chronic obstructive pulmonary disease (16% vs 9%, OR=1.96), and chronic kidney disease (23% vs 11%, OR=2.40) as compared to those without AF. We found that AF was associated with significantly higher in-hospital mortality (adjusted odds ratio [aOR] 1.24; 95% CI, 1.07 to 1.43; p < 0.005), longer LOS (adjusted mean difference 1.09 days; 95% CI, 0.67 to 1.51; p < 0.001), and higher total hospital charges (adjusted mean difference $13,514; 95% CI, $3077 to $23,952; p < 0.05). Regarding the complications, patients with AF experienced much higher rates of myocardial infarction (1% vs 0.41%, OR=2.49), acute kidney injury (33% vs 23%, OR=1.70), stroke (1.46% vs 0.96%, OR=1.53), pneumonia (12% vs 7%, OR=1.78) and encephalopathy (12% vs 8%, OR=1.58) compared to those without AF. Conclusion: In our study, we found that AF was directly linked with poorer outcomes, including higher mortality, prolonged hospital stays, increased healthcare costs, and higher complication rates in NHL patients compared to those without AF. Such patients also showed an increased comorbidity burden. These results emphasize the importance of routine screening for early identification of AF in patients with NHL. An effective multidisciplinary management of such patients may improve their clinical outcomes.