Division of Cardiology, Jefferson Einstein Hospital, Philadelphia, Pennsylvania.
Division of Internal Medicine, University of Mississippi, Jackson, Massachusetts.
Am J Cardiol. 2024 Jul 1;222:29-34. doi: 10.1016/j.amjcard.2024.04.009. Epub 2024 Apr 16.
Atrial fibrillation/flutter (AF) is the most common dysrhythmia in patients with hypertrophic cardiomyopathy (HCM). Unexplained left ventricular hypertrophy and left ventricular outflow tract obstruction are integral components of HCM pathology which can cause increased left atrial pressure and atrial myopathy contributing to the substrate for AF. We aimed to determine the impact of AF on hospital readmissions in patients with HCM. We conducted a retrospective analysis using the 2015 to 2019 Nationwide Readmission Database to analyze the effect of AF on 30-day readmission and causes of 30-day readmission in patients with HCM. We also determined the hospital, patient, and procedure-specific independent predictors of readmission in patients with HCM and AF. Of 191,235 index HCM hospitalizations, 81,390 (42.6%) had a secondary diagnosis of AF. A total of 16.9% of patients with HCM and AF were readmitted within 30 days as compared with 14% of HCM patients without AF. The presence of AF was independently associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.17 to 1.25, p <0.001). The foremost etiology of 30-day readmission in HCM patients with AF was hypertensive heart and chronic kidney disease with heart failure, whereas the foremost etiology of 30-day readmission in HCM patients without AF was sepsis. Interventions aimed toward AF management (electrical cardioversion: adjusted HR 0.91, 95% CI 0.82 to 1.01. p = 0.074, AF ablation: HR 0.92, 95% CI 0.74 to 1.13, p = 0.409, Watchman procedure: HR 1.50, 95% CI 0.16 to 14.6, p = 0.725) during index admission did not significantly impact the 30-day readmission in HCM patients with AF. Myectomy during index hospitalization (adjusted HR 0.54, 95% CI 0.34 to 0.86, p = 0.010) was most strongly associated with a lower risk of 30-day readmission in HCM patients with AF. In conclusion, in patients hospitalized for HCM, presence of AF was associated with excess risk of 30-day all-cause readmission. Interventions aimed toward HCM management, that is, myectomy rather than interventions aimed toward AF management predicted lower readmission rate in this patient population.
心房颤动/扑动（AF）是肥厚型心肌病（HCM）患者中最常见的心律失常。左心室肥厚和左心室流出道梗阻的不明原因是 HCM 病理学的组成部分，可导致左心房压力升高和心房肌病，从而导致 AF 的基质。我们旨在确定 AF 对 HCM 患者住院再入院的影响。我们使用 2015 年至 2019 年全国再入院数据库进行了回顾性分析，以分析 AF 对 HCM 患者 30 天再入院和 30 天再入院原因的影响。我们还确定了 HCM 合并 AF 患者住院、患者和手术特定的再入院独立预测因素。在 191235 例 HCM 住院患者中，有 81390 例（42.6%）有 AF 的次要诊断。与无 AF 的 HCM 患者相比，有 16.9%的 HCM 和 AF 患者在 30 天内再次入院。AF 的存在与全因 30 天再入院的风险增加独立相关（风险比[HR]1.21，95%置信区间[CI]1.17 至 1.25，p <0.001）。HCM 合并 AF 患者 30 天再入院的首要病因是高血压性心脏病和慢性肾脏病伴心力衰竭，而 HCM 患者 30 天再入院的首要病因是败血症。在指数入院期间针对 AF 管理的干预措施（电复律：调整 HR 0.91，95%CI 0.82 至 1.01，p = 0.074，AF 消融：HR 0.92，95%CI 0.74 至 1.13，p = 0.409，Watchman 手术：HR 1.50，95%CI 0.16 至 14.6，p = 0.725）并未显著影响 HCM 合并 AF 患者的 30 天再入院率。指数住院期间行心肌切除术（调整 HR 0.54，95%CI 0.34 至 0.86，p = 0.010）与 HCM 合并 AF 患者 30 天再入院风险降低最密切相关。总之，在因 HCM 住院的患者中，AF 的存在与 30 天全因再入院的风险增加有关。针对 HCM 管理的干预措施，即心肌切除术而不是针对 AF 管理的干预措施，预测了该患者人群的再入院率降低。
