Inpatient Stays Involving Atrial Fibrillation
HCUP Statistical Brief 236
Inpatient Stays Involving Atrial Fibrillation, a statistical brief from the Healthcare Cost and Utilization Project, presents data on inpatient stays involving atrial fibrillation among adults from 1998 through 2014. Atrial fibrillation, an abnormal heart rhythm or "arrhythmia" in which the upper chambers of the heart contract irregularly and inefficiently, affects 2.7-6.1 million Americans and is the most common type of heart arrhythmia. Atrial fibrillation occurs when underlying heart disease (such as ischemic heart disease, valvular heart disease, cardiomyopathy, or heart failure) damages the tissue of the atria and disrupts its ability to contract regularly. Symptoms include palpitations (fluttering sensation in the chest), dizziness, shortness of breath, syncope (fainting), and fatigue. However not all people with atrial fibrillation have symptoms, and some may be unaware that they have an arrhythmia.
Atrial fibrillation is strongly associated with increasing age (affecting 0.2 percent of people under 55 years of age but 10 percent of those over 85 years old), obesity, and diabetes. These risk factors are becoming increasingly relevant in the United States, where the population is aging, the obesity epidemic is growing, and the prevalence of diabetes is rising. Other risk factors include hypertension, previous cardiothoracic surgery, smoking, prior stroke, sleep apnea, alcohol and drug use, and hyperthyroidism.
Treatment of atrial fibrillation has two components: managing the arrhythmia and preventing stroke. The arrhythmia can be managed through either controlling the heart rate to minimize symptoms (usually through medication) or putting the heart back into a normal rhythm. Methods for restoring normal rhythm include electrical or pharmacologic cardioversion and surgical or catheter ablation.
There is some evidence that selected patients may be able to reverse atrial fibrillation through lifestyle changes that address the underlying causes of atrial fibrillation.
- Inpatient stays with atrial fibrillation increased 34.7 percent from 1998 through 2014, but the increase in recent years reflects an aging population. The age-adjusted rate increased by 20.7 percent between 1998 and 2006 (1,170 vs. 1,411 per 100,000 adults) but was largely stable after 2006.
- Although the rate of stays with atrial fibrillation stabilized for inpatients aged 65+ years after 2006, it has continued to climb for younger adults (up 21.9 percent for patients aged 45-64 years and up 10.1 percent for those aged 18-44 years).
- In 2014, the rate of inpatient stays with atrial fibrillation was highest among adults aged 85 years or older (16,309 per 100,000 adults) and patients who lived in areas with community-level income in the two lowest quartiles (1,662-1,681 per 100,000 adults) and rural areas (2,053 per 100,000 adults).
- In 1998, one in five stays with ischemic stroke also included a diagnosis of atrial fibrillation. By 2014, that number had increased to one in four stays.
- Among every adult age group, atrial fibrillation-associated stroke constituted a greater share of stroke cases in 2014 than in 1998. For example, in 2014, nearly half of stays (46.2 percent) with ischemic stroke among adults aged 85+ years involved atrial fibrillation, compared with 31.1 percent in 1998.
Page originally created February 2018