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Reflux Esophagitis is Associated with Higher Risks of Acute Stroke and Transient Ischemic Attacks in Patients Hospitalized with Atrial Fibrillation: A Nationwide Inpatient Sample Analysis

By Yi Jiang, Konstantinos Damiris, Giselle Alexandra Suero Abreu, Sushil Ahlawat

Posted 11 Aug 2020
medRxiv DOI: 10.1101/2020.08.07.20169482

Abstract Objectives: Reflux esophagitis (RE) is a subset of gastroesophageal reflux disease (GERD) with endoscopic evidence of esophageal inflammation, which has been linked to an increased incidence of atrial fibrillation (AF). However, data on the effect of RE on patient outcomes is limited. We sought to examine the potential association of RE with outcomes of patients with AF in a nationwide study. Methods: The National Inpatient Sample (NIS) database was queried to identify hospitalized adult patients with AF and RE between 2010 and 2014. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. AF related complications such as acute stroke, transient ischemic attack (TIA) and acute heart failure were assessed as secondary outcomes. Propensity score matching and multivariate regression analysis were used. Results: 667,520 patients were admitted for primary diagnosis of AF out of which 5,396 had a secondary diagnosis of RE. In the AF with RE cohort, the average age was 73.6 years, 41.5% were male, and 79.9% were Caucasian. There was a greater prevalence of concomitant dyslipidemia, chronic liver disease and chronic pulmonary disease (p <0.01) when compared to the AF without RE cohort. Patients with AF and RE also had higher incidence of acute strokes and TIAs (p<0.05), longer LOS (p<0.001), and higher hospital charges (p<0.05) with no difference in acute heart failure (p=0.08), hospital mortality (p=0.12), or CHA2DS2-VAS score (p=0.67). Conclusion: In hospitalized patients with AF, RE was associated with a higher rate of acute stroke and TIA, longer LOS, and greater hospital charges.

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