Khokhlov, Leonid

Abstract Introduction Managing atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA) is challenging and often associated with worse outcomes. Non-alcoholic fatty liver disease (NAFLD) is shown to be associated with increased cardiovascular morbidity and mortality. The effect of NAFLD on AF in patients with OSA is not well studied. This study aims to investigate this association in hospitalized patients. Methods We queried the National Inpatient Sample (NIS) between 2017-2020 for adult patients hospitalized for AF with history of OSA & had NAFLD. The primary outcome was in-hospital mortality. The secondary outcomes were cardiogenic shock, gastrointestinal bleeding (GIB), cardiac arrest, invasive mechanical ventilation (IMV) and length of stay (LOS). Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. Outcomes were adjusted for age, gender, race, heart failure, diabetes, CKD, chronic respiratory failure, stroke and history of MI. P-value < 0.05 was statistically significant. Results We identified 1,843,865 hospitalizations for AF with history of OSA: NAFLD in 61,235 (3.4%). AF with OSA and NAFLD vs. no NAFLD had mean age 68.4 vs. 70.6, males 65.2% vs. 64.1%, white 78.2% vs. 80.2%, black 9.3% vs. 10.2%, obesity 45.7% vs. 46.5%, heart failure 69.2% vs. 59.6%, diabetes 59.2% vs. 51.1%, anemia 23.5% vs. 17.2%, CKD 52.4% vs. 40% and COPD 38.2% vs. 39.1%. In-hospital mortality was 11.4% in the NAFLD group vs. 2.5% in the non-NAFLD group (aOR 5.2, P< 0.001). NAFLD vs. non-NAFLD groups had GIB 9.4% vs. 4.5% (aOR 2.1, P< 0.001), cardiac arrest 3.4% vs. 0.9% (aOR 3.4, P< 0.001), cardiogenic shock 7% vs. 1.2% (aOR 4.9, P< 0.001), IMV 10.9% vs. 3.4% (aOR 3.3, P< 0.001) and LOS 7.7 vs. 5.6 (aIRR 1.27, P< 0.001). Conclusion Our study shows that NAFLD has worsened the outcomes of patients admitted with AF and has history of OSA. The fivefold increase in in-hospital mortality is likely related to the increase in in-hospital hemorrhagic events and cardiac arrest. Clinicians should be aware of this association. Further research is needed to mitigate the detrimental effect of liver disease on OSA and AF patients. Support (if any)

Abstract Introduction Obstructive Sleep Apnea (OSA) is prevalent in heart failure and is associated with cardiovascular and all-cause mortality. The evidence is growing that Non-Alcoholic Fatty Liver Disease (NAFLD) is associated with increased cardiovascular morbidity and mortality. There is limited scientific evidence of clinical outcomes in patients with Acute Heart Failure (AHF), OSA and NAFLD. Therefore, we sought to investigate this population. Methods We queried the National Inpatient Sample (NIS) between 2017-2020 for adult patients hospitalized for AHF with history of OSA & had NAFLD. The primary outcome was in-hospital mortality. The secondary outcomes were in-hospital cardiogenic shock, gastrointestinal bleeding (GIB), cardiac arrest, invasive mechanical ventilation (IMV) and length of stay (LOS). Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was statistically significant. Results We identified 1,029,785 hospitalizations for AHF with history of OSA: NAFLD in 138,415 (3.7%). AHF with OSA and NAFLD vs. no NAFLD had mean age 65.8 vs. 67.9, males 62.2% vs. 59.2%, Caucasian race 71.6% vs. 68.7%, obesity 50.8%, 55.6%, atrial fibrillation 53.6% vs. 50.5%, diabetes 61.3% vs. 60.4%, anemia 24.8% vs. 20.3%, CKD 56.9% vs. 51.7 and COPD 42.7% vs. 48%. In-hospital mortality was 11.9% in the NAFLD group vs. 2.6% in the non-NAFLD group (aOR 5.2, P< 0.001). AHF and OSA with NAFLD vs. non-NAFLD groups had GIB 6.4% vs. 2.8% (aOR 2.4, P< 0.001), cardiac arrest 4% vs. 1.1% (aOR 3.7, P< 0.001), cardiogenic shock 13.1% vs. 2.6% (aOR 5.2, P< 0.001), IMV 13.2% vs. 5% (aOR 2.9, P< 0.001) and LOS 9.1 vs. 6.6 days (aIRR 1.3, P< 0.001). Conclusion In patients with OSA admitted for AHF, NAFLD is independently associated with five times higher odds of in-hospital mortality. It's also associated with a significantly higher incidence of cardiac arrest, cardiogenic shock, IMV and increased hospital LOS. The NAFLD group patients were younger, less obese, with more anemia and CKD. The chronic inflammatory process and humoral dysregulation associated with OSA and NAFLD would induce worsening outcomes of AHF hospitalization. Further research is needed on the impact of OSA optimization in patients with heart failure and NAFLD. Support (if any)