Prevalence and Predictors of Readmissions in Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation/Flutter

Muhammad Usman Almani; Khawaja Muhammad Talha; Laibah Arhsad Khan; Ishaque Hameed; Zain Ul Abideen Asad; Marat Fudim; Richard Krasuski; Muhammad Shahzeb Khan

doi:10.1016/j.amjcard.2024.04.009

Prevalence and Predictors of Readmissions in Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation/Flutter

Am J Cardiol. 2024 Apr 16:222:29-34. doi: 10.1016/j.amjcard.2024.04.009. Online ahead of print.

Authors

Muhammad Usman Almani¹, Khawaja Muhammad Talha², Laibah Arhsad Khan³, Ishaque Hameed⁴, Zain Ul Abideen Asad⁵, Marat Fudim⁶, Richard Krasuski⁶, Muhammad Shahzeb Khan⁷

Affiliations

¹ Division of Cardiology, Jefferson Einstein Hospital, Philadelphia, Pennsylvania.
² Division of Internal Medicine, University of Mississippi, Jackson, Massachusetts.
³ Division of Medicine, King Edward Medical University, Lahore, Pakistan.
⁴ Division of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
⁵ Division of Cardiology, University of Oklahoma, Oklahoma City, Oklahoma.
⁶ Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
⁷ Division of Cardiology, Duke University School of Medicine, Durham, North Carolina. Electronic address: shahzebkhan@gmail.com.

PMID: 38636626
DOI: 10.1016/j.amjcard.2024.04.009

Abstract

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.