Outcomes of hospitalized black patients with atrial fibrillation based on sex.

Background: Despite oral anticoagulation (AC), male patients with atrial fibrillation (AF) have worse inpatient outcomes versus females. This disparity is not well studied in Black Americans. Our objective was to evaluate in-patient outcomes of Black males hospitalized with AF versus Black females for whom AC was utilized.

Methods: We conducted a retrospective analysis of the National Inpatient Sample and identified hospitalizations of Black Americans with AF prescribed AC between 4th quarter 2015 to 2020 using ICD-10 codes. Males were compared to females with the primary endpoint of major cardiovascular events (MACE) (acute myocardial infarction, cardiogenic shock, ischemic stroke, cardiac arrest, or in-patient mortality). Secondary endpoints included any major bleeding event, length-of-stay (LOS), and adjusted hospital charges. A logistic regression model was used to control potential confounders including age, Charlson Comorbidity Index, and in-hospital mortality.

Results: A total of 180,650 Black patient hospitalizations were identified with AF prescribed AC, among which, 83,135 (46 %) were male. Males had more baseline comorbidities. After adjusting for selected confounders, Black males had higher odds of MACE (adjusted odds ratio [aOR] 1.16), major bleeding event (aOR 1.34), longer LOS (5.7 vs. 5.5 days), and higher adjusted hospital charges ($68,227 vs. $63,027); all p < 0.05.

Conclusions: In this "real life" inpatient cohort, compared with Black females, Black males with AF prescribed AC exhibit higher rates of MACE and major bleeding.