Abstract Body (Do not enter title and authors here): Background: Atrial fibrillation (AF) is the most prevalent arrhythmia. Protein-energy malnutrition (PEM) has been implicated in various cardiovascular conditions, but the studies on its impact on AF outcomes are limited. This study aims to investigate the relationship between PEM and AF outcomes, since malnutrition could be a modifiable risk factor.
Methods: Utilizing data from NIS (2017–2020), patients of age more than 18 years with a primary diagnosis of AF and a secondary diagnosis of PEM were identified. Data analysis was performed using STATA, employing the Student's t-test and Fischer's exact test to compare continuous variables and proportions, respectively. Adjusted odds ratios were calculated through multivariate regression analysis. The primary outcome was mortality, with secondary outcomes being mean length of stay (LOS), total hospitalization cost, major adverse cardiovascular events (MACE) and various in-hospital complications. Trends in mortality, LOS, and total cost of hospitalization were also assessed.
Results: A total of 17,652,695 patients with AF were identified, of whom 1,452,695 (8.22%) had PEM. Patients with PEM had increased mortality (10.8% vs 4.52%, p<0.001), increased mean LOS (10.14 days vs 5.52 days, p<0.001) and a higher hospitalization cost ($121,721 vs 69,348, p<0.001). In AF patients with PEM compared to those without PEM, there were significantly increased rates of ACS (adjusted odds ratio, or aOR=1.21, 2.48 vs 1.85, p<0.001), pulmonary edema (aOR=1.37, 0.61 vs 0.44, p<0.001), CVA (aOR=1.45, 1.7 vs 1.04, p<0.001) acute respiratory failure (aOR=1.78, 20.27 vs 11.75, p<0.001), need of mechanical ventilation (aOR= 2.46, 9.36 vs 3.96, p<0.001), ARDS (aOR= 2.8, 0.55 vs 0.21, p<0.001), AKI (aOR=1.57, 35.45 vs 24.12, p<0.001), and septic shock (aOR= 3.32, 10.3 vs 3.24, p<0.001). There is an increased trend of mortality (10.77 in 2017 vs 11.87 in 2020, p<0.001), LOS (10.49 in 2017 vs 10.8 in 2020, p=0.04) and total hospitalization cost ($121,233 in 2017 vs $140,869 in 2020, p<0.001) in patients with AF and PEM.
Conclusion: Our study highlights the association between PEM and adverse AF outcomes, revealing PEM as a significant predictor of increased mortality, morbidity, length of stay, and hospitalization costs. These results emphasize the necessity for targeted nutritional interventions in AF management. Further research and clinical strategies addressing nutritional deficits in AF populations are essential for improving outcomes.