Hospitalization trends for thromboembolic events in atrial fibrillation: A 12-year national analysis

Direct oral anticoagulants and percutaneous left atrial appendage occlusion (LAAO) devices were approved for use in 2010 and 2015, respectively. It is unknown to what extent, if any, these new stroke preventive therapies have impacted hospitalizations for thromboembolic (TE) events.

To evaluate temporal trends in AF-related hospitalizations for acute ischemic stroke (AIS), transient ischemic attack (TIA), and systemic embolism (SEE) in the U.S. from 2010 to 2021.

Using the National Inpatient Sample, we identified hospitalizations for TE events with comorbid AF. Data were grouped into two periods (2010-2015 and 2016-2021). Linear regression assessed trends in TE frequency. We also examined anticoagulation (AC) use and LAAO procedures among inpatients with AF.

A total of 1,692,373 AF-related TE hospitalizations were identified: 798,413 (2010-2015) and 893,960 (2016-2021). The frequency of hospitalizations for any AF-TE event, as a fraction of total hospitalizations in patients with AF, declined from 3.69 % to 3.35 % (P < 0.001). AF-related AIS hospitalizations rose from 2.71 % to 2.89 % in 2010-2015 (P < 0.001) but declined from 3.02 % to 2.89 % in 2016-2021 (P < 0.001). TIA (0.75 % to 0.35 %) and SEE (0.22 % to 0.10 %) hospitalizations also decreased (P < 0.001). AC use increased from 21.2 % in 2010 to 42.4 % in 2021 (P < 0.001), while LAAO procedures rose sharply from 5129 in 2016 to 46,080 in 2021 (P < 0.001).

TE hospitalizations among inpatients with comorbid AF declined from 2010 to 2021, primarily driven by a decrease in TIAs and SEE. Acute ischemic stroke hospitalizations declined after 2016, coinciding with increased AC use and LAAO adoption.