Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis
Bibliographic record
Abstract
Background: Orthostatic hypotension and atrial fibrillation have common etiology and a bidirectional relationship with several cardiovascular conditions. Despite both conditions being highly prevalent in hospitalized patients, prior research has primarily evaluated adverse outcomes due to orthostatic hypotension and atrial fibrillation independent of each other. In this study, we aim to assess if the presence of atrial fibrillation exacerbates in-hospital outcomes of patients with orthostatic hypotension. Methods: Adult patients hospitalized in 2019 with a primary diagnosis of orthostatic hypotension with or without pre-existing atrial fibrillation were identified using the International Classification of Diseases, Tenth Revision (ICD-10) code. The primary outcome of interest was in-patient mortality and cardiac arrest. Secondary outcomes of interest were the length of stay and total hospital charges. Adjusted and unadjusted analysis was performed on appropriate variables of interest. Results: Among 10,630 hospitalizations with orthostatic hypotension, 2,987 (median (interquartile range (IQR)) age: 78.5 (68.5 - 88.5) years; 1,197 women (40.1%)) comprised the atrial fibrillation cohort. Mean Charlson comorbidity index was noted to be significantly higher in orthostatic hypotension and atrial fibrillation patients (mean (standard deviation (SD)): 3.1 (2.1) vs. 2.5 (2.1), P < 0.001).Compared to orthostatic hypotension patients without atrial fibrillation, the prevalence of congestive heart failure (1,263 (42.3%) vs. 1,367 (17.9%)), coronary artery disease (1,432 (47.9%) vs. 2,481 (32.5%)), history of percutaneous coronary intervention or graft (443 (14.83%) vs. 860 (11.3%)), chronic obstructive pulmonary disease (644 (21.6%) vs. 1,131 (14.8%)) , chronic kidney disease (1,182 (39.6%) vs. 2,216 (29.0%)), and hyperlipidemia (1,828 (61.2%) vs. 4,087 (53.5%); all P < 0.05), were significantly higher in orthostatic hypotension patients with atrial fibrillation. Following multivariable analysis of orthostatic hypotension patients, atrial fibrillation was associated with 5.0 times greater odds for cardiac arrest (adjusted odds ratio (aOR) = 5.0 (95% confidence interval (CI): 1.4 - 18.2), P = 0.014), without increased risk of in-hospital mortality (aOR = 2.1 (95% CI: 0.9 - 5.0), P = 0.090). Conclusions: Atrial fibrillation is an independent predictor for cardiac arrest but not in-hospital mortality in patients with orthostatic hypotension. The short- and long-term prognostic value of atrial fibrillation in orthostatic hypotension patients must be confirmed in future prospective trials to improve patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".