Abstract
Atrial fibrillation (AF) is associated with an increased rate of mortality, heart
failure, and stroke. We conducted an observational study to assess the relationship
between anticoagulation and adverse clinical outcomes in hospitalized patients with
AF. We performed a 5,000-consecutive-patient retrospective cohort analysis of anticoagulation
prescription and 90-day outcomes in patients with AF hospitalized at Brigham and Women's
Hospital from May 2008 to September 2014. All-cause mortality at 90 days was 5.4%.
The frequency of death between hospital discharge and day 90 was lower in patients
who were anticoagulated at discharge (2.8 vs. 7.1%, p < 0.001). Anticoagulation prescription at discharge was associated with a 60% reduction
in death between discharge and day 90, after adjustment for confounding factors. Major
adverse events at day 90, including death, myocardial infarction, stroke, and major
bleeding, were more frequent in patients who were not prescribed anticoagulation at
discharge (16.5 vs. 10.4%, p < 0.001). In multivariable regression analysis, prescription of anticoagulation at
discharge predicted a lower mortality (adjusted odds ratio (OR), 0.4; 95% confidence
interval (CI), 0.3–0.53) and lower major adverse event rate (adjusted OR, 0.64; 95%
CI, 0.54–0.76) by day 90. In conclusion, all-cause mortality at 90 days was high among
inpatients with AF. Patients with AF who were not prescribed anticoagulation at discharge
had an increased risk of death at 90 days. Hospitalization represents a special opportunity
to optimize cardiovascular risk reduction strategies, including anticoagulation.
Keywords
anticoagulation - atrial fibrillation - mortality - adverse events
