Abstract 13627: Atrial Fibrillation is Associated With Worse Outcomes in Saddle Embolus of Pulmonary Artery Without Cor-Pulmonale

Background: Pulmonary embolism (PE) is a common form of venous thromboembolism that could be potentially fatal. Atrial fibrillation (AF) is the most common arrhythmia, which may lead to thromboembolic complications. They are distinct medical conditions, but PE may lead to AF through right-sided pressure overload. AF, in turn, might lead to right atrial thrombus formation and, thereby, PE. AF can be seen as a presenting sign during early phase or later during recovery from PE.

Methods: This is a retrospective cohort study in which we queried the National Inpatient Sample database between 2016 and 2019 to identify hospitalizations (age 18 and older) with a principal diagnosis of Saddle embolus of pulmonary artery without acute cor-pulmonale. The cohort was divided into patients with and without AF as a secondary diagnosis. The primary outcome was in-hospital mortality. The secondary outcomes were cardiogenic shock, acute respiratory failure, length of stay, and total hospital charges. All statistical analyses were performed using weighted values.

Results: During the study period, there were 58,285 hospitalizations with a principal diagnosis of Saddle embolus of pulmonary artery without acute cor-pulmonale. Among them, 5800 (11%) had a diagnosis of AF. Baseline characteristics are shown in Table 1. After adjusting for all significant baseline characteristics, patients admitted with concomitant AF had higher in-hospital mortality (6.6% vs 3.7%; aOR 1.88, 95% CI:1.46 - 2.42, p < 0.0001), cardiogenic shock (5.9% vs 2.0%; aOR 3.04, 95% CI: 2.3 - 4.0, p < 0.0001), acute respiratory failure (4.2% vs 2.7%; aOR 1.65; 95% CI: 1.14 - 2.15), increased length of stay (7.59 vs 5.44 days p < 0.0001), total hospital charges ($100,756 vs $ 69,396 p < 0.0001)

Conclusions: This study demonstrates that AF is associated with increased mortality, cardiogenic shock, acute respiratory failure, length of stay, and total hospital charges in saddle embolus of pulmonary artery without cor- pulmonale