Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample...

Area of Science:

• Cardiology
• Geriatric Medicine
• Hospital Medicine

Background:

• Orthostatic hypotension and atrial fibrillation are common in hospitalized patients, often sharing etiological factors and bidirectional cardiovascular relationships.
• Previous research has largely examined the adverse outcomes of orthostatic hypotension and atrial fibrillation independently.
• This study investigates whether the presence of atrial fibrillation exacerbates in-hospital outcomes for patients diagnosed with orthostatic hypotension.

Purpose of the Study:

• To determine if atrial fibrillation exacerbates in-hospital outcomes in patients with orthostatic hypotension.
• To assess the independent impact of atrial fibrillation on mortality and cardiac arrest in orthostatic hypotension patients.
• To identify potential risk factors and comorbidities associated with combined orthostatic hypotension and atrial fibrillation.

Main Methods:

• Retrospective analysis of adult patients hospitalized in 2019 with a primary diagnosis of orthostatic hypotension.
• Utilized International Classification of Diseases, Tenth Revision (ICD-10) codes for patient identification.
• Primary outcomes included in-patient mortality and cardiac arrest; secondary outcomes were length of stay and total hospital charges. Adjusted and unadjusted analyses were performed.

Main Results:

• The study identified 10,630 hospitalizations for orthostatic hypotension, with 2,987 patients having co-existing atrial fibrillation.
• Patients with both conditions exhibited a significantly higher Charlson comorbidity index and higher prevalence of heart failure, coronary artery disease, COPD, kidney disease, and hyperlipidemia.
• Atrial fibrillation was associated with a 5-fold increased odds of cardiac arrest (aOR=5.0, P=0.014) but not in-hospital mortality (aOR=2.1, P=0.090) in multivariable analysis.

Conclusions:

• Atrial fibrillation independently predicts cardiac arrest in patients with orthostatic hypotension.
• Atrial fibrillation does not appear to increase the risk of in-hospital mortality in this patient cohort.
• Prospective trials are necessary to confirm the prognostic value of atrial fibrillation in orthostatic hypotension and guide improved patient management.