Introduction: Recent studies point to a significant association between obstructive sleep apnea (OSA) and atrial fibrillation (AF). This association has important implications in ablation strategies and success rate. Studies evaluating the predictors of readmission in patients with AF show reduced readmission rates in those who undergo AF ablation. There are limited data on the predictors of readmission in patients with both AF and OSA including effects of AF ablation and DC cardioversion (DCCV) on readmission rate.
Methods: Using the US 2014 National Readmission Database we included patients admitted with a primary diagnosis of AF who also had a diagnosis of OSA. ICD-9 codes were used to identify AF, OSA, other comorbidities and inpatient procedures and complications. Odds ratios were adjusted for age, gender, Charlson comorbidity index, hospital bed size and teaching status. We used logistic regression to determine statistical significance.
Results: A total of 48,660 patients were included (34.7% females) with a mean age of 64.4 years. There were 6,212 readmissions (12.76%) within 30 days after discharge. Table1 Catheter ablation in initial admission was associated with lower odds of 30 day readmission (OR: 0.78 p: 0.005). There is a trend toward lower rates of readmission after DCCV but this difference is not statistically significant (OR: 0.86 p: 0.053). Major predictors for readmission were cardiogenic shock (OR:2.23 p:0.006) and acute respiratory failure (OR:1.37 p:0.012) during initial admission as well as Charlson comorbidity Index ≥ 3 (OR: 1.96 p<0.001), ESRD (OR:1.56 p <0.001) and female gender (OR:1.35 p <0.001). Table 2
Conclusion: Catheter ablation is protective for 30 day readmission in patients with AF and OSA but this protective effect was not significant for those undergoing DCCV. Female gender, ESRD and more comorbidities on presentation and acute respiratory failure and cardiogenic shock during initial admission were predictive of readmission.