Temporal Trends in Thromboembolic Event Hospitalizations in Patients with Atrial Fibrillation in the United States

BackgroundDirect oral anticoagulants and percutaneous left atrial appendage occlusion (LAAC) devices were approved for use in 2010 and 2015, respectively. It is unknown to what extent, if any, these new stroke preventive therapies have impacted hospitalizations for thromboembolic (TE) events in the United States. MethodsWe used the National Inpatient Sample database to describe trends over time in AF-related hospitalizations for acute ischemic stroke (AIS), transient ischemic attacks (TIA), and systemic embolic events (SEE) between 2010 and 2021. Trends in anticoagulation use (AC) and percutaneous LAAC procedures among hospitalized patients with AF were also analyzed. ResultsA total of 1,692,373 hospitalizations for TE were identified between 2010 and 2021: 798,413 from 2010 to 2015 (mean age 78.9 [standard deviation (SD) 10.7] years; 57.8% female) and 893,960 from 2016 to 2021 (mean age 77.5 [SD 10.9] years; 53.1% female). There was a significant increase in rates of AC use (21.2% of inpatients with AF in 2010 vs 42.4% of inpatients with AF in 2021; Ptrend <0.001) and rates of percutaneous LAAC procedures (0.1/100,000 US adults vs to 17.7/100,000 US adults Ptrend <0.001) among inpatients with AF. Between 2010 to 2021, age-adjusted AIS hospitalizations increased (30.8 hospitalizations /100,000 US adults vs 35.9 hospitalizations/ 100,000 US adults; Ptrend <0.001) and peaked in 2019. Age-adjusted SEE hospitalizations (2.5 hospitalizations /100,000 US adults vs 1.3 hospitalizations/ 100,000 US adults; Ptrend <0.001) and TIA hospitalization(8.5 hospitalizations /100,000 US adults vs 4.3 hospitalizations/ 100,000 US adults; Ptrend <0.001) peaked in 2011 and then decreased. Between 2016 and 2021, age-adjusted AIS hospitalizations plateaued (37.7 hospitalizations/100,000 US adults vs 35.9 hospitalizations/100,000 US adults; APC -4.7%; Ptrend = 0.197). The total of all TE hospitalizations remained stable (41.8 hospitalizations/100,000 US adults vs 41.5 hospitalizations/100,000 US adults; Ptrend 0.689). ConclusionDespite increased anticoagulant and the initial use of percutaneous LAAO, AF-associated TE event hospitalizations in the US have remained stable from 2010 to 2021. Hospitalizations for AF-related TIA and SEE consistently decreased from 2010 to 2021 while AF-related AIS hospitalizations increased from 2010 to 2015 and then plateaued from 2016 to 2021.