Do Patients with Liver Cirrhosis Have Worse Outcomes in Newly Diagnosed Atrial Fibrillation/Flutter?

Background/Objectives Atrial fibrillation/flutter (AF) and liver cirrhosis both present a large disease burden internationally, with millions of adults afflicted. There is evidence of a link between these two diseases; however, the prevalence and impact of liver cirrhosis in patients with and without AF have not been extensively detailed. With the utilization of a large national database, we examined the relationship between liver cirrhosis and AF and the effects on hospital outcomes. Methods We conducted a nationwide review from 2016 to 2020 utilizing the Nationwide Inpatient Sample (NIS) database. Patients ≥ 18 years old with newly diagnosed atrial fibrillation or atrial flutter were identified. They were then further stratified into patients with and without liver cirrhosis. Characteristics and comorbidities were identified, evaluating in-hospital mortality as the primary outcome. Results A total of 3,866,486 patients with a primary diagnosis of AF were included. Patients with liver cirrhosis were younger in age (mean age 68.32 vs 74.36 years old), the majority were White (74.1%), followed by Black (10.2%), and Hispanic (10.5%). They had more comorbidities, such as diabetes (45.1% vs 37.3%, p<0.001), hypertension (78.5% vs 83.6%, p<0.01), and chronic kidney disease (22.1% vs 19.5%, p<0.001) when compared to patients without liver cirrhosis. Patients with liver cirrhosis had a higher risk of in-hospital mortality (OR=1.84, p<0.001), hypovolemic shock (OR=2.17, p<0.001), gastrointestinal bleed (OR=2.42, p<0.001), requiring blood transfusions (OR=1.84, p<0.001), and requiring ICU-level of care with intubation (OR=1.214, p<0.001), central line (OR=1.33, p<0.001), arterial line (OR=1.32, p<0.001) and vasopressors (OR=1.61, p<0.001). Moreover, patients with liver cirrhosis had a lower risk of having an acute cerebrovascular accident (OR=0.431), transient ischemic attack (OR=0.475), or pulmonary embolism (OR=0.68) while hospitalized (p<0.001). Conclusion Our results have demonstrated a remarkable relationship between AF and liver cirrhosis, with significantly increased morbidity and mortality reported in individuals with both conditions compared to AF without liver cirrhosis.