Patients with atrial fibrillation (AFib) who are admitted to rural hospitals have a 17 percent increased risk of death during their stay compared to those admitted to urban facilities, researchers reported in HeartRhythm.

The study included 248,731 hospitalizations for AFib between 2012 and 2014 using the National Inpatient Sample. Patients were 69 years old on average, 78 percent white and 52 percent men. Twelve percent of the admissions were to rural hospitals and the other 88 percent were to urban hospitals.

Lead investigator Wesley T. O’Neal, MD, MPH, and colleagues adjusted for multiple variables in finding the 17 percent increased risk of all-cause mortality in AFib patients at rural hospitals. Subgroup analyses by sex, race and region yielded similar results.

"Since we have identified rural hospitals as locations where in-hospital mortality for AFib admission is possibly higher than other areas of the country, our findings will drive future research endeavors to uncover the reasons for this difference, and to develop strategies to improve the medical care for patients with this heart rhythm disturbance," O’Neal et al. wrote.

The five most common secondary diagnoses in the hospitalized patients were heart failure, hypertension, hyperlipidemia, diabetes and acute kidney injury.

In a related editorial, Thomas F. Deering, MD, FHRS, and Ashish A. Bhimani, MD, FHRS, pointed out other unknown confounders may have contributed to the study’s results. Access to care, patient compliance, physician adherence to guideline recommendations and physician referral patterns may have factored into patient outcomes, they said.

“Claims-based analyses, such as these, should be viewed as hypothesis-generating instead of categorical in nature,” Deering and Bhimani wrote. “The electrophysiology and medical communities should look at the findings presented in this study as a motivational call to initiate prospective studies with the goal of identifying gaps in AFib care, which can then be used to create effective healthcare policies designed to reduce AFib-related mortality.”