Prevalence and outcomes of atrial fibrillation in hospitalizations during pregnancy and puerperium.

BACKGROUND

Atrial fibrillation (AF) is a common cardiac arrhythmia, but data on the impact during delivery remains limited.

OBJECTIVES

The aim of the study is to examine a) the prevalence of AF during pregnancy and puerperium, b) the association between AF and adverse outcomes, and c) the association between adverse cardiovascular outcomes and CHA2DS2-VASc scores in patients with AF.

METHODS

The National Inpatient Sample (NIS) database was used to identify pregnancy-related hospitalizations between 2008 and 2017. Adverse outcomes included: in-hospital mortality, stroke, acute heart failure, cardiogenic shock, acute kidney failure, and acute myocardial infarction. Logistic models were constructed to explore the relationship between AF and adverse outcomes.

RESULTS

Of 40,996,860 pregnancy- and puerperium-related hospitalizations, 15,162 (0.037%) also had AF. The prevalence of AF increased from 2.18 (95%CI = 2.04-2.31) per 10,000 hospitalizations in 2008 to 4.87 (95%CI = 4.65-5.09) per 10,000 in 2017 (P trend < 0.001). The proportion of patients with AF increased with advanced maternal age (P trend < 0.001). The prevalence of AF was higher in Black individuals, those from low-income households, and those with advanced maternal age (P trend < 0.001). Maternal patients with AF had significantly higher in-hospital mortality (OR = 2.02, 95%CI = 1.56-2.61, P < 0.001). Stroke, acute myocardial infarction, acute heart failure, and cardiogenic shock were associated with increasing CHA2DS2-VASc scores in patients with AF (P trend < 0.001).

CONCLUSIONS

The prevalence of AF has been increasing in the pregnant and puerperium population and is associated with adverse outcomes. Higher CHA2DS2-VASc scores are associated with adverse outcomes in maternal patients with AF.