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Effect of Bariatric Surgery on Emergency Department Visits and Hospitalizations for Atrial Fibrillation

      Atrial fibrillation (AF) and obesity are major health problems in the United States. However, little is known about whether bariatric surgery affects AF-related morbidities. This study investigated whether bariatric surgery is associated with short-term and long-term changes in the risk of emergency department (ED) visits or hospitalizations for AF. We performed a self-controlled case series study of obese adults with AF who underwent bariatric surgery by using population-based ED and inpatient databases in California, Florida, and Nebraska from 2005 to 2011. The primary outcome was ED visit or hospitalization for AF. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using presurgery months 13 to 24 as a reference period. Our sample consisted of 523 obese adults with AF who underwent bariatric surgery. The median age was 57 years (interquartile range 48 to 64 years), 59% were female, and 84% were non-Hispanic white. During the reference period, 15.9% (95% confidence interval [CI] 12.7% to 19.0%) of patients had an ED visit or hospitalization for AF. The risk remained similar in the subsequent 12-month presurgery period (adjusted OR [aOR] 1.29 [95% CI, 0.94 to 1.76] p = 0.11). In contrast, the risk significantly increased within 12 months after bariatric surgery (aOR 1.53 [95% CI 1.13 to 2.07] p = 0.006). The risk remained elevated during 13–24 months after bariatric surgery (aOR 1.41 [95% CI, 1.03 to 1.91] p = 0.03). In conclusion, this population-based study demonstrated that bariatric surgery was associated with an increased risk of AF episodes requiring an ED visit or hospitalization for at least 2 years after surgery among obese patients with AF.
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      References

        • Go A.S.
        • Hylek E.M.
        • Phillips K.A.
        • Chang Y.
        • Henault L.E.
        • Selby J.V.
        • Singer D.E.
        Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
        JAMA. 2001; 285: 2370-2375
        • Miyasaka Y.
        • Barnes M.E.
        • Gersh B.J.
        • Cha S.S.
        • Bailey K.R.
        • Abhayaratna W.P.
        • Seward J.B.
        • Tsang T.S.
        Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence.
        Circulation. 2006; 114: 119-125
        • Chen L.Y.
        • Sotoodehnia N.
        • Buzkova P.
        • Lopez F.L.
        • Yee L.M.
        • Heckbert S.R.
        • Prineas R.
        • Soliman E.Z.
        • Adabag S.
        • Konety S.
        • Folsom A.R.
        • Siscovick D.
        • Alonso A.
        Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study.
        JAMA Intern Med. 2013; 173: 29-35
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States. 2011–2012.
        JAMA. 2014; 311: 806-814
        • Abed H.S.
        • Wittert G.A.
        • Leong D.P.
        • Shirazi M.G.
        • Bahrami B.
        • Middeldorp M.E.
        • Lorimer M.F.
        • Lau D.H.
        • Antic N.A.
        • Brooks A.G.
        • Abhayaratna W.P.
        • Kalman J.M.
        • Sanders P.
        Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial.
        JAMA. 2013; 310: 2050-2060
        • Gloy V.L.
        • Briel M.
        • Bhatt D.L.
        • Kashyap S.R.
        • Schauer P.R.
        • Mingrone G.
        • Bucher H.C.
        • Nordmann A.J.
        Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials.
        BMJ. 2013; 347: f5934
        • Jamaly S.
        • Carlsson L.
        • Peltonen M.
        • Jacobson P.
        • Sjostrom L.
        • Karason K.
        Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects.
        J Am Coll Cardiol. 2016; 68: 2497-2504
        • Inge T.H.
        • Courcoulas A.P.
        • Jenkins T.M.
        • Michalsky M.P.
        • Helmrath M.A.
        • Brandt M.L.
        • Harmon C.M.
        • Zeller M.H.
        • Chen M.K.
        • Xanthakos S.A.
        • Horlick M.
        • Buncher C.R.
        • Teen-LABS Consortium
        Weight loss and health status 3 years after bariatric surgery in adolescents.
        N Engl J Med. 2016; 374: 113-123
        • Overview of the State Emergency Department Databases (SEDD)
        Healthcare Cost and Utilization Project.
        (Available at:) (Accessed May 22, 2017)
        • Overview of the State Inpatient Databases (SID)
        Healthcare Cost and Utilization Project.
        (Available at:) (Accessed May 22, 2017)
        • Whitaker H.J.
        • Farrington C.P.
        • Spiessens B.
        • Musonda P.
        Tutorial in biostatistics: the self-controlled case series method.
        Stat Med. 2006; 25: 1768-1797
        • Shimada Y.J.
        • Tsugawa Y.
        • Brown D.F.
        • Hasegawa K.
        Bariatric surgery and emergency department visits and hospitalizations for heart failure exacerbation: population-based, self-controlled series.
        J Am Coll Cardiol. 2016; 67: 895-903
        • Hasegawa K.
        • Tsugawa Y.
        • Chang Y.
        • Camargo Jr, C.A.
        Risk of an asthma exacerbation after bariatric surgery in adults.
        J Allergy Clin Immunol. 2015; 136 (e8): 288-294
        • Shimada Y.J.
        • Tsugawa Y.
        • Iso H.
        • Brown D.F.M.
        • Hasegawa K.
        Association between bariatric surgery and risk of hospitalizations for stable angina pectoris in obese adults.
        Heart. 2017; (In Press)https://doi.org/10.1136/heartjnl-2016-310757
        • Nguyen G.C.
        • Patel A.M.
        Racial disparities in mortality in patients undergoing bariatric surgery in the U.S.A.
        Obes Surg. 2013; 23: 1508-1514
        • Hasegawa K.
        • Tsugawa Y.
        • Camargo Jr, C.A.
        • Brown D.F.
        Frequent utilization of the emergency department for acute heart failure syndrome: a population-based study.
        Circ Cardiovasc Qual Outcomes. 2014; 7: 735-742
        • Alpert M.A.
        • Lambert C.R.
        • Panayiotou H.
        • Terry B.E.
        • Cohen M.V.
        • Massey C.V.
        • Hashimi M.W.
        • Mukerji V.
        Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss.
        Am J Cardiol. 1995; 76: 1194-1197
        • Iacobellis G.
        • Ribaudo M.C.
        • Leto G.
        • Zappaterreno A.
        • Vecci E.
        • Di Mario U.
        • Leonetti F.
        Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity.
        Obes Res. 2002; 10: 767-773
        • Otto M.E.
        • Belohlavek M.
        • Khandheria B.
        • Gilman G.
        • Svatikova A.
        • Somers V.
        Comparison of right and left ventricular function in obese and nonobese men.
        Am J Cardiol. 2004; 93: 1569-1572
        • Alpert M.A.
        • Agrawal H.
        • Aggarwal K.
        • Kumar S.A.
        • Kumar A.
        Heart failure and obesity in adults: pathophysiology, clinical manifestations and management.
        Curr Heart Fail Rep. 2014; 11: 156-165
        • Luaces M.
        • Cachofeiro V.
        • Garcia-Munoz-Najar A.
        • Medina M.
        • Gonzalez N.
        • Cancer E.
        • Rodriguez-Robles A.
        • Canovas G.
        • Antequera-Perez A.
        Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery.
        Rev Esp Cardiol (Engl Ed). 2012; 65: 14-21
        • de las Fuentes L.
        • Waggoner A.D.
        • Mohammed B.S.
        • Stein R.I.
        • Miller 3rd, B.V.
        • Foster G.D.
        • Wyatt H.R.
        • Klein S.
        • Davila-Roman V.G.
        Effect of moderate diet-induced weight loss and weight regain on cardiovascular structure and function.
        J Am Coll Cardiol. 2009; 54: 2376-2381
        • Ashrafian H.
        • le Roux C.W.
        • Darzi A.
        • Athanasiou T.
        Effects of bariatric surgery on cardiovascular function.
        Circulation. 2008; 118: 2091-2102
        • McCloskey C.A.
        • Ramani G.V.
        • Mathier M.A.
        • Schauer P.R.
        • Eid G.M.
        • Mattar S.G.
        • Courcoulas A.P.
        • Ramanathan R.
        Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy.
        Surg Obes Relat Dis. 2007; 3: 503-507
        • Owan T.
        • Avelar E.
        • Morley K.
        • Jiji R.
        • Hall N.
        • Krezowski J.
        • Gallagher J.
        • Williams Z.
        • Preece K.
        • Gundersen N.
        • Strong M.B.
        • Pendleton R.C.
        • Segerson N.
        • Cloward T.V.
        • Walker J.M.
        • Farney R.J.
        • Gress R.E.
        • Adams T.D.
        • Hunt S.C.
        • Litwin S.E.
        Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study.
        J Am Coll Cardiol. 2011; 57: 732-739
        • Maasland L.
        • van Oostenbrugge R.J.
        • Franke C.F.
        • Scholte Op Reimer W.J.
        • Koudstaal P.J.
        • Dippel D.W.
        • Netherlands Stroke Survey Investigators
        Patients enrolled in large randomized clinical trials of antiplatelet treatment for prevention after transient ischemic attack or ischemic stroke are not representative of patients in clinical practice: the Netherlands Stroke Survey.
        Stroke. 2009; 40: 2662-2668
        • Van Spall H.G.
        • Toren A.
        • Kiss A.
        • Fowler R.A.
        Eligibility criteria of randomized controlled trials published in high-impact general medical journals: a systematic sampling review.
        JAMA. 2007; 297: 1233-1240
        • Heintz K.M.
        • Hollenberg S.M.
        Perioperative cardiac issues: postoperative arrhythmias.
        Surg Clin North Am. 2005; 85 (viii): 1103-1114
        • Svane M.S.
        • Madsbad S.
        Bariatric surgery—effects on obesity and related co-morbidities.
        Curr Diabetes Rev. 2014; 10: 208-214
        • Hasegawa K.
        • Tsugawa Y.
        • Brown D.F.
        • Camargo Jr, C.A.
        A population-based study of adults who frequently visit the emergency department for acute asthma. California and Florida, 2009–2010.
        Ann Am Thorac Soc. 2014; 11: 158-166