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Preexisting Atrial Fibrillation Associated with Higher Mortality in Patients with Methicillin-Resistant

Timothy McCann¹, Michael Fatuyi¹, Neha Patel¹

¹Internal Medicine Department, TriHealth-Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati 45220, Ohio, USA.

Interdisciplinary Perspectives on Infectious Diseases

|August 1, 2022

Abstract

Background:

The purpose of this study was to investigate the prevalence of preexisting atrial fibrillation (AF) in patients with MRSA-BSI during a three-year period and the impact of preexisting AF on MRSA-BSI outcomes.

Methods:

This was a retrospective analysis performed using the National Inpatient Sample (NIS) over a three-year period (2016, 2017, 2018) for patients with MRSA-BSI as a principal diagnosis with and without preexisting AF. The primary outcome was mortality with secondary outcomes of acute coronary syndrome, cardiac arrest, cardiogenic shock, endocarditis, respiratory failure, acute kidney injury, length of stay, hospital cost, and patient charge. A univariate and multivariable logistic regression analysis estimated clinical outcomes.

Results:

Preexisting AF in patients with MRSA-BSI significantly increased the primary outcome of the study, mortality (1.67% vs. 0.66%, p=0.030) with an adjusted odds ratio (AOR) of 1.98 (95% CI, 1.1-3.7). Secondary outcomes showed increased likelihood of cardiac arrest with MRSA-BSI and AF (0.48% vs. 0.2%, p=0.025) with an AOR 3.59 (CI 1.18-11.0), ACS (3.44% vs. 1.21%, p=0.008) with an AOR of 1.81 (CI 1.16-2.80), respiratory failure (8.92% vs. 4.02%, p=0.045) with an AOR 1.39 (CI 1.01-1.91), prolonged LOS (6.4 vs. 5.4 days, p=0.0001), increased hospital cost ($13,374 vs. $11,401, p=0.0001), and increased overall patient charge ($50,091 vs. $43,018, p=0.0001). Secondary outcomes that showed statistical significance included ACS (1,497 (3.44%) vs. 113 (1.21%), p=0.008) with an AOR of 1.81 (CI 1.16-2.80), cardiac arrest (209 (0.48%) vs. 19 (0.2%), p=0.025) with an AOR 3.59 (CI 1.18-11.0), and respiratory failure (3,881 (8.92%) vs. 374 (4.02%), p=0.045 with an AOR 1.39 (CI 1.01-1.91).

Conclusions:

Preexisting AF is a significant risk factor for mortality in patients admitted for MRSA-BSI and increases risk for cardiac arrest, respiratory failure, and ACS. Considerations should focus on early treatment and source control, especially with AF given the mortality risk, increased hospitalization cost, and prolonged LOS.

Insights

Preexisting atrial fibrillation (AF) significantly increases mortality and complications in patients with methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSI). Early intervention is crucial for patients with AF and MRSA-BSI to mitigate risks and improve outcomes.

Area of Science:

Infectious Diseases
Cardiology
Health Services Research

Background:

Investigating the prevalence of pre-existing atrial fibrillation (AF) in patients diagnosed with methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSI).
Examining the impact of pre-existing AF on MRSA-BSI patient outcomes, including mortality and secondary complications.

Purpose of the Study:

To determine the prevalence of pre-existing atrial fibrillation (AF) among patients with MRSA-BSI.
To analyze the association between pre-existing AF and adverse outcomes in patients with MRSA-BSI.

Main Methods:

Retrospective analysis of the National Inpatient Sample (NIS) database from 2016-2018.
Inclusion criteria: patients with MRSA-BSI as a principal diagnosis, with and without pre-existing AF.
Primary outcome: mortality. Secondary outcomes: acute coronary syndrome, cardiac arrest, respiratory failure, length of stay, hospital cost, and patient charge. Statistical analysis included univariate and multivariable logistic regression.

Main Results:

Pre-existing AF was associated with significantly increased mortality in MRSA-BSI patients (1.67% vs. 0.66%, p=0.030; AOR=1.98).
Increased likelihood of cardiac arrest (AOR=3.59), acute coronary syndrome (ACS) (AOR=1.81), and respiratory failure (AOR=1.39) in patients with AF and MRSA-BSI.
Patients with AF and MRSA-BSI experienced prolonged length of stay (LOS), increased hospital costs, and higher patient charges compared to those without AF.

Conclusions:

Pre-existing atrial fibrillation is a significant risk factor for mortality in MRSA-BSI patients.
AF exacerbates risks for cardiac arrest, respiratory failure, and ACS in the context of MRSA-BSI.
Early treatment, source control, and focused management are crucial for patients with AF and MRSA-BSI due to elevated mortality risk and healthcare utilization.

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