PGY-2 IM Resident NYC Health and Hospitals/Lincoln Bronx, New York, United States
Objective: Studies have shown that thyrotoxicosis can trigger or cause Atrial Fibrillation (AF). Literature is lacking studies that describe the impact of thyrotoxicosis on AF admissions in terms of in-hospital mortality and other hospital outcomes.
Methods: Patients admitted with a primary diagnosis of AF with or without a subsequent diagnosis of thyrotoxicosis were found in the National Inpatient Sample (NIS) Database from 2016 to 2019. Patients were separated into two groups: those with thyrotoxicosis and those without. Univariate and multivariate logistic regression analyses were used to control for frequent confounders and compare the risk of mortality and in-hospital outcomes between the two groups.
Results: A total of 1,329,950 patients were admitted with AF as a primary diagnosis during this period. Thyrotoxicosis was diagnosed in 24,754 patients (1.8%). The average age of the aggregate cohort was 70 years old, 52% were female, and 81% were a white race. The average length of stay (LOS) was 3.2 days and the average total hospital charges were 40,048 $. The total number of patients who died during the hospitalization was 11,574 patients. The previous history of thyrotoxicosis was not associated with an increased risk of in-hospital mortality (OR 0.91, 95% CI 0.63 –1.3, p=0.613) in AF hospitalizations. Thyrotoxicosis was not linked to an increased risk of cardiac outcomes like acute coronary syndrome (OR 0.88, 95% CI 0.73-1.06, p=0.2), cardiac arrest (OR 0.97, 95% CI 0.6-1.5, p=0.91), ventricular tachycardia (OR 0.91, 95% CI 0.76-1.09, p=0.327), ventricular fibrillation (OR 0.9, 95% CI 0.44-1.8, P=0.791) or hypertensive emergency (OR 0.66, 95% CI 0.34-1.27, P=0.22). The risk of acute respiratory failure (OR 1.14, 95% CI 0.97-1.35, p=0.103) or pulmonary edema (OR 1.11, 95% CI 0.82-1.5, p=0.492) was not statistically different between the two groups.
Discussion/Conclusion: This study strongly implies that thyrotoxicosis doesn’t impact patients admitted with atrial fibrillation in terms of in-hospital mortality and other hospital outcomes including acute coronary syndrome, cardiac arrest, ventricular tachycardia, ventricular fibrillation, or hypertensive emergency.