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Burden of arrhythmia and electrophysiologic procedures in alcoholic cardiomyopathy hospitalizations
Samian Sulaiman1, Nazdar Yousef2, Mina M Benjamin1
1Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Nearly half of alcoholic cardiomyopathy hospitalizations involve arrhythmias, primarily atrial fibrillation, which increased over time. While not increasing mortality, these arrhythmias led to longer stays and higher costs.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Limited national data exist on arrhythmia prevalence and electrophysiological (EP) procedure use in alcoholic cardiomyopathy (CMP).
- Alcoholic CMP is a significant health concern, and understanding associated arrhythmias is crucial for patient management.
Purpose of the Study:
- To determine the prevalence and trends of arrhythmias in patients hospitalized with alcoholic CMP.
- To investigate the utilization of EP procedures in this patient population.
- To analyze the association of arrhythmias with in-hospital mortality, length of stay, and hospital charges.
Main Methods:
- A cross-sectional study utilizing the Nationwide Inpatient Sample database from 2007-2014.
- Identified adult hospitalizations with alcoholic CMP using ICD-9 code 425.5, excluding other cardiomyopathy causes.
- Employed statistical analyses including chi-square tests, t-tests, mixed-effect logistic regression, and quantile regression.
Main Results:
- Among 75,430 hospitalizations, 48% had arrhythmias, predominantly atrial fibrillation/flutter (31.5%).
- Arrhythmia prevalence increased from 44% to 50% (2007-2014), driven by rising atrial fibrillation.
- Arrhythmias were linked to longer hospital stays (5 vs. 4 days) and higher total charges ($31,127 vs. $24,199), but not increased in-hospital mortality (excluding cardiac arrest). EP procedures were performed in 5.6% of cases.
Conclusions:
- Nearly half of alcoholic cardiomyopathy hospitalizations involve arrhythmias, with a notable increase in atrial fibrillation prevalence.
- While not directly increasing in-hospital mortality, arrhythmias significantly prolong hospital stays and elevate healthcare costs.
- The findings highlight the substantial burden of arrhythmias in alcoholic cardiomyopathy and underscore the need for effective management strategies.
Background:
Limited national US data are available regarding the prevalence of and trends in different arrhythmias and the use of electrophysiological procedures in patients with alcoholic cardiomyopathy.
Methods:
This was a cross-sectional study that used the Nationwide Inpatient Sample database (2007-2014). Hospitalizations of adults with alcoholic CMP were identified with the ICD-9 code (425.5). CAD and other causes of cardiomyopathy were excluded. Chi-square test, t-test, mixed-effect logistic regression and quantile regression were used.
Results:
Among 75,430 hospitalizations, 48% had arrhythmias. Individuals with a co-diagnosis of arrhythmia tended to be older (56.9 vs 53.2-year-old) and male (89.5% vs 81.9%). The most prevalent arrhythmias were atrial fibrillation/flutter (31.5%), followed by ventricular tachycardia (7.9%). The prevalence of arrhythmias increased from 44% to 50% (2007-2014) (p < 0.001) and this increase was mainly secondary to the increasing prevalence AFib/AFL. Excluding cardiac arrest, arrhythmias were not associated with increased in-hospital mortality. The median length of stay and total charges for arrhythmia vs no-arrhythmia hospitalizations were 5 vs 4 days (p < 0.001) and $31,127 vs $24,199 respectively (p < 0.001). EP procedures were performed in 5.6% of all hospitalizations and it increased from 5.2% to 6% (2007-2014) (p = 0.2). The most common procedures were cardioversion (2.7%), ICD placement (2.2%) and PPM placement (1.1%).
Conclusion:
Arrhythmias were reported in 48% of hospitalizations. There was an increasing burden of arrhythmias secondary to increasing atrial fibrillation. Excluding cardiac arrest, arrhythmias were not associated with increased in-hospital mortality but were associated with longer hospital stays and higher total charges.
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