Prevalence and Predictors of Readmissions in Patients With Hypertrophic Cardiomyopathy and Atrial...

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Atrial fibrillation/flutter (AF) is a common dysrhythmia in hypertrophic cardiomyopathy (HCM).
• HCM pathology, including left ventricular hypertrophy and outflow tract obstruction, can lead to increased left atrial pressure and atrial myopathy, predisposing to AF.
• Understanding the impact of AF on hospital readmissions in HCM is crucial for patient management.

Purpose of the Study:

• To determine the impact of AF on 30-day hospital readmissions in patients with HCM.
• To identify the primary causes of 30-day readmission in HCM patients with and without AF.
• To ascertain hospital, patient, and procedure-specific predictors of readmission in HCM patients with AF.

Main Methods:

• Retrospective analysis of the 2015-2019 Nationwide Readmission Database.
• Inclusion of index hospitalizations for HCM.
• Analysis of secondary diagnosis of AF and its association with 30-day readmission rates and causes.

Main Results:

• Of 191,235 index HCM hospitalizations, 42.6% had a secondary diagnosis of AF.
• HCM patients with AF had a higher 30-day readmission rate (16.9%) compared to those without AF (14%).
• AF was independently associated with increased all-cause 30-day readmission (HR 1.21).
• Top readmission cause for HCM with AF was hypertensive heart and CKD with HF; for HCM without AF, it was sepsis.
• AF management interventions (cardioversion, ablation, Watchman) did not significantly impact 30-day readmission.
• Myectomy during index hospitalization was strongly associated with lower 30-day readmission risk (aHR 0.54).

Conclusions:

• The presence of AF in hospitalized HCM patients is linked to an elevated risk of 30-day all-cause readmission.
• Interventions focused on HCM management, specifically myectomy, appear more effective in reducing readmission rates than AF-focused interventions in this population.
• Further research into optimizing management strategies for HCM patients with AF is warranted.