Jackson Inimfon, Etuk Aniekeme S, Jackson Nsikak
Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, USA.
Internal Medicine, Thomas Hospital Infirmary Health, Fairhope, USA.
Cureus. 2022 May 23;14(5):e25252. doi: 10.7759/cureus.25252. eCollection 2022 May.
Background Though multiple myeloma (MM) patients have been reported to have the highest risk of atrial fibrillation compared to other cancer patients, studies are lacking on the impact of atrial fibrillation on health outcomes in this population. In this study, we examined the impact of atrial fibrillation on inpatient outcomes among hospitalized patients with MM. Methodology Retrospective cohort analyses were conducted using National Inpatient Sample data from 2016 to 2018. Descriptive analyses were performed to explore the prevalence of atrial fibrillation among MM patients. Multivariable logistic and linear regression models were used to examine the association between atrial fibrillation and inpatient all-cause mortality, length of stay, and total hospital charges among hospitalized patients with MM. Results Overall, 13.1% of the patients reported having atrial fibrillation. MM patients with atrial fibrillation had 1.2 times (adjusted odds ratio (AOR) = 1.16; 95% confidence interval (CI) = 1.05-1.29) higher odds of inpatient all-cause mortality when compared to those without atrial fibrillation. They were also 1.3 times (AOR = 1.29; 95% CI = 1.23-1.35) more likely to have a length of stay of more than five days relative to five days or less. Additionally, MM patients with atrial fibrillation had $8,020 (95% CI = $5,495.2-$10,546.3) higher hospital costs when compared to their counterparts without atrial fibrillation. Stratified results by the use of anticoagulation further showed that MM patients who were not using anticoagulation had bad health outcomes, reporting higher odds of inpatient all-cause mortality (AOR = 1.40; 95% CI = 1.25-1.57), a longer length of hospital stay of more than five days (AOR = 1.44; 95% CI = 1.36-1.53), and total hospital charges (β = $14,772.5; 95% CI = $11,467.8-$18,077.3). Conclusions Our findings stress the need for monitoring and possible screening to detect atrial fibrillation in MM patients as anticoagulation helps improve mortality in these patients. Medication reconciliation remains a key component of hospital admissions/discharges and may help in decreasing the length of stay and healthcare costs.
尽管有报道称，与其他癌症患者相比，多发性骨髓瘤（MM）患者发生心房颤动的风险最高，但关于心房颤动对该人群健康结局影响的研究却很缺乏。在本研究中，我们调查了心房颤动对住院MM患者住院结局的影响。
利用2016年至2018年的全国住院患者样本数据进行回顾性队列分析。进行描述性分析以探究MM患者中心房颤动的患病率。使用多变量逻辑回归和线性回归模型来研究心房颤动与住院MM患者的全因死亡率、住院时间和总住院费用之间的关联。
总体而言，13.1%的患者报告有心房颤动。与没有心房颤动的患者相比，患有心房颤动的MM患者的住院全因死亡率高1.2倍（调整优势比[AOR]=1.16；95%置信区间[CI]=1.05-1.29）。相对于住院时间为五天或更短的患者，他们住院时间超过五天的可能性也高1.3倍（AOR=1.29；95%CI=1.23-1.35）。此外，与没有心房颤动的患者相比，患有心房颤动的MM患者的住院费用高出8020美元（95%CI=5495.2美元-10546.3美元）。按抗凝药物使用情况进行分层的结果进一步显示，未使用抗凝药物的MM患者健康结局较差，其住院全因死亡率更高（AOR=1.40；95%CI=1.25-1.57），住院时间超过五天的可能性更大（AOR=1.44；95%CI=1.36-1.53），总住院费用也更高（β=14772.5美元；95%CI=11467.8美元-18077.3美元）。
我们的研究结果强调了对MM患者进行监测和可能的筛查以检测心房颤动的必要性，因为抗凝治疗有助于改善这些患者的死亡率。用药核对仍然是住院/出院的关键组成部分，可能有助于缩短住院时间和降低医疗费用。
