Atrial fibrillation is an independent risk factor for mortality among patients hospitalized for alcoholic cardiomyopathy: a nationwide in-patient analysis

Introduction Alcoholic cardiomyopathy (ACM) is dilated cardiomyopathy resulting from chronic alcohol consumption and is associated with significant mortality. Atrial fibrillation (AF) frequently coexists with ACM, but its specific impact on patients hospitalized with ACM remains unclear. We aimed to evaluate the association of co-existing AF with short-term clinical outcomes in ACM. Methods A retrospective cohort study was performed using the United States National Inpatient Sample database for 2021. Inpatient mortality, total hospital charges, length of hospital stay, mechanical ventilation rates, and vasopressor use were compared between patients aged 18 or older, with and without atrial fibrillation. Univariate logistic and linear regression analyses were used for hypothesis testing; multivariate regression analyses were then used to adjust for confounders. Student T-test and Pearson’s chi-square test were used to compare population demographic features. Analyses were performed using STATA/BE 18.0. Significance was set at 0.05. Results Of 590 ACM admissions identified, 145(25%) had atrial fibrillation. There was no significant difference in age (53 vs. 50 years; p=0.32) or gender (p=0.44) between the subgroups. The in-hospital mortality rate was 10.3% and 1.1% among those with and without atrial fibrillation, respectively (Odds ratio, OR=10.2; p=0.049). When adjusted for age, race, gender, Charlson comorbidity index (baseline functional status), and size of healthcare facility in a multivariate logistic regression analysis, atrial fibrillation remained significantly associated with increased mortality risk (OR= 20.2; p<0.001) and became significantly associated with increased vasopressor support (OR=6.05; p=0.049) among ACM patients. There were no significant differences in total hospital charges (p=0.063) or length of hospital stay (p=0.081) on adjusted analyses. Conclusion Coexisting atrial fibrillation in patients hospitalized with alcoholic cardiomyopathy independently correlates with markedly higher in-hospital mortality and an increased need for vasopressor support. These patients require close monitoring and proactive management of atrial fibrillation. Further research is needed to elucidate this topic.