Socioeconomic Disparities in Readmission Outcomes and Cardiac Procedures Among Atrial Fibrillation Hospitalizations

Introduction Atrial fibrillation (AF) remains one of the leading dysrhythmias incurring hospitalization. We set out to determine the impact of socioeconomic status (SES) on in‐hospital cardiac procedures and the readmission outcomes in patients with AF. Methods The National Readmission Database (NRD) was searched for adults with a primary diagnosis of AF between 2010 and 2019. We determined unplanned AF‐specific readmission within 30 days. Median neighborhood household income was assessed by patient zip code as quartiles: low income (Q1), middle income (Q2), upper‐middle income (Q3), and high income (Q4). Differences in in‐hospital cardiac procedures during the index hospitalization and probability of 30‐day readmission across income quartiles were determined. Yearly trends in adjusted all‐cause 30‐day readmission rates were also assessed by income quartiles. Results We identified 2,946,767 index AF hospitalizations between 2010 and 2019. Q4 patients were more likely to undergo echocardiography, left atrial appendage occlusion, electrical cardioversion, and AF ablation during the index hospitalization. Q4 patients were 17% less likely to have readmission for any cause and 12% less likely to have AF‐specific readmission within 30 days compared to the Q1 patients. All‐cause and AF‐specific readmission rates (AFRRs) for Q1 patients had a linear rising trend from 2010 to 2019. Among Q4 patients, all‐cause readmission rate (ACRR) remained the same, and AFRR had a linear decline. Conclusions Among patients hospitalized for AF in the United States (US) from 2010 to 2019, adjusted all‐cause and AF‐specific 30‐day readmission rates significantly differed by neighborhood household income. Over the years, the 30‐day readmission outcomes disparity among income quartiles appeared to be widening.