# Sex-related disparities in incidence and in-hospital outcomes of Atrial fibrillation complicated by non-ST-elevation myocardial infarction from the national in-sample database (2016–2022)

## TL;DR

This study shows that men and women with atrial fibrillation and non-ST-elevation myocardial infarction have different hospital outcomes and resource use in the U.S.

## Contribution

The study identifies sex-based disparities in incidence, outcomes, and hospital resource use for AF complicated by NSTEMI.

## Key findings

- Females had higher mortality rates and longer hospital stays compared to males with AF complicated by NSTEMI.
- Males showed higher age-adjusted mortality rates and increasing hospital costs over the study period.
- Significant gender differences were found in clinical characteristics and resource utilization for AF with NSTEMI.

## Abstract

•
What is already known
•AF complicated by NSTEMI has a significant association with a higher all-cause and cardiovascular mortality and patients with AF complicated by NSTEMI have a comparatively worse prognosis than AF patients without NSTEMI.•
How do the findings change practice?
•Our study revealed significant sex-based disparities in the incidence, clinical characteristics, resource utilization, and in-hospital outcomes of AF complicated by NSTEMI in the U.S. adult population.

What is already known

AF complicated by NSTEMI has a significant association with a higher all-cause and cardiovascular mortality and patients with AF complicated by NSTEMI have a comparatively worse prognosis than AF patients without NSTEMI.

How do the findings change practice?

Our study revealed significant sex-based disparities in the incidence, clinical characteristics, resource utilization, and in-hospital outcomes of AF complicated by NSTEMI in the U.S. adult population.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, and if complicated by NSTEMI has a significant association with a higher all-cause and cardiovascular mortality. Previous studies show that patients with AF complicated by NSTEMI have a comparatively worse prognosis than AF patients without NSTEMI.

In this study, we aimed to assess the trends and gender-based disparities in the incidence and in-hospital outcomes of AF complicated by NSTEMI in the U.S. adult population, using data from the Nationwide Inpatient Sample (NIS) dataset. The NIS database was searched from 2016 to 2022 to identify patients with ICD-10 Codes. Baseline demographic characteristics along with hospital-level variables were analyzed subsequently using the odds ratio.

The demographic, clinical, and hospital-related characteristics of the study population were stratified by gender including 125,340 males and 88,554 females. The average age of patients was 75.14 years, with males being younger (73.58 years) compared to females (77.35 years) (p < 0.001). Overall, 10.8 % of the patients died; females had a significantly higher mortality rate (11.3 %) than males (10.5 %) (p < 0.001). The trends in age-adjusted mortality rate (AAMR) was 19996.9 per 100,000 hospitalizations in males who demonstrated higher AAMRs than females (18156.5). The mean length of hospital stay was consistently longer for the males compared to the females. The trend analysis for inflation-adjusted hospital costs demonstrated an upward trend in both males (p < 0.001) and females (p < 0.001).

These findings underscore the importance of addressing gender-specific differences in the management of AF patients with NSTEMI to optimize patient resource allocation.