Atrial fibrillation and short-term outcomes after cancer-related ischemic stroke

Abstract

Introduction: Atrial fibrillation (AF) and cancer are each associated with worse outcomes in patients with acute ischemic stroke (AIS). Few studies have evaluated the impact of AF on outcomes of cancer-related stroke. Patients and methods: We conducted a retrospective cross-sectional study using the 2016–2019 National Inpatient Sample, identifying all hospitalizations with diagnosis codes for cancer and AIS. The primary exposure was a diagnosis of AF. The primary outcome was in-hospital mortality. The secondary outcomes were length-of-stay and discharge to non-home locations. We used multiple logistic and linear regression models, adjusted for age, gender, race-ethnicity, and the Charlson Comorbidity Index, to examine the association between AF and study outcomes. Results: Among 150,200 hospitalizations with diagnoses of cancer and AIS (mean age 72 years, 53% male), 40,084 (26.7%) included comorbid AF. Compared to hospitalizations without AF, hospitalizations with AF had higher rates of in-hospital mortality (14.8% [95% CI, 14.0%−15.6%] vs 12.1% [95% CI, 11.6%−12.5%]) and non-home discharge disposition (83.5% [95% CI, 82.7%−84.3%] vs 75.1% [95% CI, 74.5%−75.7%]) as well as longer mean length-of-stay (8.4 days [95% CI, 8.2–8.6 days] vs 8.2 days [95% CI, 8.0–8.3 days]). In multivariable analyses, AF remained independently associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR], 1.34; 95% CI, 1.24–1.46), non-home discharge disposition (aOR, 1.32; 95% CI, 1.23–1.42), and longer length-of-stay (adjusted mean difference, 13.7%; 95% CI, 10.9%−16.7%). Discussion and conclusion: In cancer-related AIS, comorbid AF is associated with worse short-term outcomes, including higher odds for in-hospital mortality, poor discharge disposition, and longer hospital stays.