Patient characteristics, care patterns, and outcomes of atrial fibrillation associated hospitalizations in patients with chronic kidney disease and end-stage renal disease - 30/10/21
Résumé |
Background |
Chronic Kidney Disease (CKD) and end-stage renal disease (ESRD) are associated with poor outcomes in patients with cardiovascular disease. There is a paucity of contemporary data on in-hospital outcomes and care patterns of atrial fibrillation (AF) associated hospitalizations CKD and ESRD.
Methods |
Outcomes and care patterns were evaluated in GWTG-AFIB database (Jan 2013-Dec 2018), including in-hospital mortality, use of a rhythm control strategy, and oral anticoagulation (OAC) prescription at discharge among eligible patients. Generalized logistic regression models with generalized estimating equations were used to ascertain differences in outcomes. Hospital-level variation in OAC prescription and rhythm control was also evaluated.
Results |
Among 50,154 patients from 105 hospitals the median age was 70 years (interquartile range 61-79) and 47.3% were women. The prevalence of CKD was 36.0% while that of ESRD was 1.6%. Among eligible patients, discharge OAC prescription rates were 93.6% for CKD and 89.1% for ESRD. After adjustment, CKD and ESRD were associated with higher in-hospital mortality (odds ratio [OR] 3.08, 95% confidence interval [CI] 1.57-6.03 for ESRD and OR 2.02, 95% CI 1.52-2.67 for CKD), lower odds of OAC prescription at discharge (OR 0.59, 95% CI 0.44-0.79 for ESRD and OR 0.84, 95% CI 0.75-0.94 for CKD) compared with normal renal function. CKD was associated with lower utilization of rhythm control strategy (OR 0.92, 95% CI 0.87-0.98) with no significant difference between ESRD and normal renal function (OR 1.32, 95% CI 0.79-1.11). There was large hospital-level variation in OAC prescription at discharge (MOR 2.34, 95% CI 2.05-2.76) and utilization of a rhythm control strategy (MOR 2.69, 95% CI 2.34-3.21).
Conclusions |
CKD/ESRD is associated with higher in-hospital mortality, less frequent rhythm control, and less OAC prescription among patients hospitalized for AF. There is wide hospital-level variation in utilization of a rhythm control strategy and OAC prescription at discharge highlighting potential opportunities to improve care and outcomes for these patients, and better define standards of care in this patient population
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Keywords : Atrial fibrillation, End-stage renal disease, Chronic kidney disease, hospitalization, Outcomes Research
Plan
Vol 242
P. 45-60 - décembre 2021 Retour au numéro
Article précédent
- Text messages for primary prevention of cardiovascular disease: The TextMe2 randomized clinical trial
- Harry Klimis, Aravinda Thiagalingam, Daniel McIntyre, Simone Marschner, Amy Von Huben, Clara K. Chow
- Cardiac pathology 6 months after hospitalization for COVID-19 and association with the acute disease severity
- Peder L. Myhre, Siri L. Heck, Julia B. Skranes, Christian Prebensen, Christine M. Jonassen, Trygve Berge, Albulena Mecinaj, Woldegabriel Melles, Gunnar Einvik, Charlotte B. Ingul, Arnljot Tveit, Jan Erik Berdal, Helge Røsjø, Magnus N. Lyngbakken, Torbjørn Omland
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?