The impact of atrial fibrillation on amyloidosis: insight from the national inpatient sample database

SESSION TITLE: Cardiovascular Disease Posters 5 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: Amyloidosis is a systemic disease with the accumulation of fibril-shaped aggregates of misfolded proteins on various organs, leading to significant morbidity and mortality. Deposition of amyloid on the cardiac conduction system can lead to arrhythmias, the most common of which is atrial fibrillation (AF). The aim of this study is to evaluate the impact of AF on the clinical outcomes of patients with amyloidosis. METHODS: We conducted a retrospective study utilizing the National Inpatient Sample (NIS) data 2017 and 2018. All patients above 18 years old with a diagnosis of amyloidosis with or without coexisting AF were identified using the International Classification of Diseases 10th revision, Clinical Modification codes. Multivariate regression analysis was used to estimate the odds ratio of in-hospital mortality, the average length of stay (LOS), and total hospital charges after adjusting for cofounders. Statistical analysis was performed by using STATA version 17 (StataCorp, College Station, TX). RESULTS: We included 6,975 patients with the diagnosis of amyloidosis, of which 1,240 (18%) of them had concurrent AF. Patients with co-existing AF were significantly older than those without AF, with a mean age of 74.3 years (p<0.001) and included a greater proportion of males (65% vs 53%, p=0.002). Patients with co-existing amyloidosis and AF had a significantly higher risk of congestive heart failure (75% vs 40%, p<0.001), renal failure (37% vs 28%, p=0.006), heart block (10% vs 3%, p=0.006), ventricular tachycardia (9% vs 5%, p=0.017), and restrictive cardiomyopathy (11% vs 5%, p<0.001) compared to those without AF. Interestingly, patients with amyloidosis without concurrent AF had a greater risk of developing stroke relative to those with concurrent AF (42% vs 23%, p<0.001). They were also found to have significantly higher inpatient mortality (8% vs 6.7%, adjusted odd ratio 1.39, p=0.003). However, the LOS and total hospital chargers were not statistically significant between the two groups. CONCLUSIONS: Amyloidosis with AF is associated with a higher inpatient mortality rate, heart failure, renal failure, heart block, and ventricular tachycardia. Optimizing the management of AF in patients with amyloidosis is of utmost importance to improve the outcomes. CLINICAL IMPLICATIONS: To raise awareness of the association between amyloidosis and atrial fibrillation because patients with concurrent amyloidosis and atrial fibrillation have higher inpatient mortality rate. DISCLOSURES: No relevant relationships by Aakash Goyal No disclosure on file for Swe Swe Hlaing No relevant relationships by Trishna Kattel No relevant relationships by Hui Chong Lau No relevant relationships by Sze Jia Ng