Association of psychosocial factors with all-cause hospitalizations in patients with atrial fibrillation

Abstract

Background: A high burden of cardiovascular comorbidities puts patients with atrial fibrillation (AF) at high risk for hospitalizations, but the role of other factors is less clear.

Hypothesis: To determine the relationship between psychosocial factors and the risk of unplanned hospitalizations in AF patients.

Methods: Prospective observational cohort study of 2378 patients aged 65 or older with previously diagnosed AF across 14 centers in Switzerland. Marital status and education level were defined as social factors, depression and health perception were psychological components. The pre-defined outcome was unplanned all-cause hospitalization.

Results: During a median follow-up of 2.0 years, a total of 1713 hospitalizations occurred in 37% of patients. Compared to patients who were married, adjusted rate ratios (aRR) for all-cause hospitalizations were 1.28 (95% confidence interval [CI], 0.97-1.69) for singles, 1.31 (95%CI, 1.06-1.62) for divorced patients, and 1.02 (95%CI, 0.82-1.25) for widowed patients. The aRRs for all-cause hospitalizations across increasing quartiles of health perception were 1.0 (highest health perception), 1.15 (95%CI, 0.84-1.59), 1.25 (95%CI, 1.03-1.53), and 1.66 (95%CI, 1.34-2.07). No different hospitalization rates were observed in patients with a secondary or primary or less education as compared to patients with a college degree (aRR, 1.06; 95%CI, 0.91-1.23 and 1.05; 95%CI, 0.83-1.33, respectively). Presence of depression was not associated with higher hospitalization rates (aRR, 0.94; 95%CI, 0.68-1.29).

Conclusions: The findings suggest that psychosocial factors, including marital status and health perception, are strongly associated with the occurrence of hospitalizations in AF patients. Targeted psychosocial support interventions may help to avoid unnecessary hospitalizations.

Trial registration: ClinicalTrials.gov Identifier NCT02105844.

Keywords: atrial fibrillation; health perception; psychosocial factors; unplanned hospitalization.

Conflict of interest statement

Dr Bonati reports personal fees and nonfinancial support from Amgen, grants from AstraZeneca, personal fees and nonfinancial support from Bayer, personal fees from Bristol‐Myers Squibb, personal fees from Claret Medical, grants from Swiss National Science Foundation, grants from University of Basel, grants from Swiss Heart Foundation, outside the submitted work. Dr Sticherling has received speaker honoraria from Biosense Webster and Medtronic and research grants from Biosense Webster, Daiichi‐Sankyo, and Medtronic. Dr Schwenkglenks reports grants from Swiss National Science Foundation, during the conduct of the study; grants and personal fees from Amgen, grants from MSD, grants from Novartis, grants from Pfizer, grants from The Medicines Company, outside the submitted work. Dr Kühne reports personal fees from Bayer, grants from Bayer, personal fees from Pfizer‐BMS, personal fees from Daiichi‐Sankyo, personal fees from Böhringer‐Ingelheim, outside the submitted work. Dr Conen received consulting fees from Servier, Canada, outside of the current work. The remaining authors have nothing to disclose.

© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

Figures

FIGURE 1

Cumulative Incidence of All‐Cause Hospitalization According to Psychosocial Factors. Cumulative incidence of all‐cause hospitalization according to marital status, A, education level, B, presence of depression, C, and quartiles of health perception, D. For health perception, the 1. quartile indicates health perception between 100 to 86; 2. quartile between 85 to 81; 3. quartile between 80 to 61; 4. quartile below 61