Table 1.
Demographic and clinical characteristics of patients stratified by obesity and AF status
| Variables | Overall population (n = 25,654) |
AF | No AF | p-value* | |||||
|---|---|---|---|---|---|---|---|---|---|
| Obesity (n = 3735) |
No obesity (n = 6279) |
Obesity (n = 5531) |
No obesity (n = 10,109) |
||||||
| Age, years | 67.0 (55.7–77.5) | 70.4 (62.6–77.6) | 76.8 (67.5–84.2) | 60.3 (50.1–69.6) | 62.8 (50.7–74.0) | < 0.001 | |||
| Age group, n (%) | < 0.001 | ||||||||
| < 65 years | 11,530 (44.9%) | 1201 (32.2%) | 1230 (19.6%) | 3504 (63.4%) | 5595 (55.4%) | ||||
| 65–74 years | 6283 (24.5%) | 1280 (34.3%) | 1577 (25.1%) | 1245 (22.5%) | 2181 (21.6%) | ||||
| 75–84 years | 5222 (20.4%) | 960 (25.7%) | 2113 (33.7%) | 622 (11.3%) | 1527 (15.1%) | ||||
| ≥85 years | 2619 (10.2%) | 294 (7.9%) | 1359 (21.6%) | 160 (2.89%) | 806 (8.0%) | ||||
| Women, n (%) | 10,420 (40.6%) | 1516 (40.6%) | 2382 (37.9%) | 2435 (44.0%) | 4087 (40.4%) | < 0.001 | |||
| BMI, kg/m2 | 27.77 (24.2–32.3) | 34.4 (31.9–38.3) | 25.4 (22.8–27.6) | 34.3 (31.8–38.3) | 25.2 (22.5–27.4) | < 0.001 | |||
| Ethnicity | < 0.001 | ||||||||
| White, n (%) | 17,400 (67.8%) | 2726 (73.0%) | 4585 (73.0%) | 3585 (64.8%) | 6504 (64.3%) | ||||
| Black, n (%) | 2189 (8.5%) | 295 (7.9%) | 358 (5.7%) | 624 (11.3%) | 912 (9.0%) | ||||
| Asian, n (%) | 636 (2.5%) | 25 (0.67%) | 197 (3.1%) | 48 (0.9%) | 366 (3.6%) | ||||
| Hispanic/Latino, n (%) | 838 (3.3%) | 99 (2.7%) | 130 (2.1%) | 228 (4.1%) | 381 (3.8%) | ||||
| Other/Unknown, n (%) | 4591 (17.9%) | 590 (15.8%) | 1009 (16.1%) | 1046 (18.9%) | 1946 (19.3%) | ||||
| Marital status | < 0.001 | ||||||||
| Married, n (%) | 12,079 (47.1%) | 1868 (50.0%) | 3221 (51.3%) | 2528 (45.7%) | 4462 (44.1%) | ||||
| Divorced, n (%) | 1814 (7.1%) | 292 (7.8%) | 389 (6.2%) | 430 (7.8%) | 703 (7.0%) | ||||
| Single, n (%) | 6567 (25.6%) | 822 (22.0%) | 1081 (17.2%) | 1677 (30.3%) | 2987 (29.6%) | ||||
| Widowed, n (%) | 2905 (11.3%) | 466 (12.5%) | 1115 (17.8%) | 397 (7.2%) | 927 (9.2%) | ||||
| Other/Unknown, n (%) | 2289 (8.9%) | 287 (7.7%) | 473 (7.5%) | 499 (9.0%) | 1030 (10.2%) | ||||
| Insurance | < 0.001 | ||||||||
| Medicare, n (%) | 1773 (6.9%) | 136 (3.6%) | 205 (3.3%) | 534 (9.7%) | 898 (8.9%) | ||||
| Medicaid, n (%) | 11,196 (43.6%) | 1938 (51.9%) | 3726 (59.3%) | 1872 (33.9%) | 3660 (36.2%) | ||||
| Other, n (%) | 12,685 (49.5%) | 1661 (44.5%) | 2348 (37.4%) | 3125 (56.5%) | 5551 (54.9%) | ||||
| Admission type | < 0.001 | ||||||||
| Emergency/urgency, n (%) | 18,407 (71.8%) | 2587 (69.3%) | 4303 (68.5%) | 4036 (73.0%) | 7481 (74.0%) | ||||
| Elective, n (%) | 1296 (5.1%) | 275 (7.4%) | 514 (8.2%) | 181 (3.3%) | 326 (3.2%) | ||||
| Other, n (%) | 5951 (23.2%) | 873 (23.4%) | 1462 (23.3%) | 1314 (23.8%) | 2302 (22.8%) | ||||
| Severity Scores | |||||||||
| SOFA | 4.0 (2.0–7.0) | 5.0 (3.0–8.0) | 5.0 (3.0–8.0) | 4.0 (2.0–7.0) | 4.0 (2.0–6.0) | < 0.001 | |||
| LODS | 4.0 (2.0–6.0) | 5.0 (3.0–7.0) | 5.0 (3.0–7.0) | 4.0 (2.0–6.0) | 4.0 (2.0–6.0) | < 0.001 | |||
| APS III | 40.0 (30.0–55.0) | 45.0 (33.0–60.0) | 44.0 (33.0–59.0) | 38.0 (28.0–53.0) | 38.0 (28.0–52.0) | < 0.001 | |||
| OASIS | 32.0 (26.0–38.0) | 33.0 (27.0–39.0) | 34.0 (28.0–40.0) | 31.0 (25.0–37.0) | 31.0 (25.0–36.0) | < 0.001 | |||
| SAPS II | 36.0 (27.0–45.0) | 39.0 (31.0–49.0) | 40.0 (33.0–49.0) | 33.0 (24.0–42.0) | 33.0 (25.0–42.0) | < 0.001 | |||
| SIRS | 3.0 (2.0–3.0) | 3.0 (2.0–3.0) | 3.0 (2.0–3.0) | 3.0 (2.0–3.0) | 3.0 (2.0–3.0) | 0.003 | |||
| Vital signs | |||||||||
| Heart rate, bpm | 85.8 (76.4–98.2) | 87.1 (78.0-100.7) | 85.3 (76.4–97.9) | 86.8 (77.0-98.7) | 85.2 (75.5–97.3) | < 0.001 | |||
| Systolic blood pressure, mmHg | 117.2 (108.2-129.6) | 116.6 (108.0-128.4) | 115.4 (106.9-126.5) | 119.4 (110.2-132.8) | 117.3 (108.0-129.8) | < 0.001 | |||
| Diastolic blood pressure, mmHg | 62.9 (56.4–71.0) | 61.8 (55.7–69.6) | 60.6 (54.6–68.1) | 64.5 (57.8–73.2) | 63.7 (57.1–71.8) | < 0.001 | |||
| Mean blood pressure, mmHg | 78.0 (72.1–86.1) | 77.3 (71.7–84.6) | 76.2 (70.9–83.3) | 79.7 (73.2–88.4) | 78.6 (72.5–86.7) | < 0.001 | |||
| Respiratory rate, breaths per minute | 19.2 (17.0-22.2) | 20.0 (17.7–23.0) | 19.5 (17.0-22.6) | 19.4 (17.2–22.4) | 18.7 (16.5–21.5) | < 0.001 | |||
| Oxygen saturation, (%) | 97.7 (96.3–98.9) | 97.6 (96.3–98.6) | 97.9 (96.6–99.0) | 97.3 (95.9–98.5) | 97.9 (96.5–99.0) | < 0.001 | |||
| Comorbidities | |||||||||
| Hypertension, n (%) | 11,523 (44.9%) | 1739 (46.6%) | 2844 (45.3%) | 2730 (49.4%) | 4210 (41.67%) | < 0.001 | |||
| Coronary artery disease, n (%) | 9929 (38.7%) | 1898 (50.8%) | 3169 (50.5%) | 1850 (33.5%) | 3012 (29.8%) | < 0.001 | |||
| Myocardial infarction, n (%) | 4970 (19.4%) | 872 (23.4%) | 1552 (24.7%) | 964 (17.4%) | 1582 (15.7%) | < 0.001 | |||
| Cardiomyopathy, n (%) | 928 (3.6%) | 203 (5.4%) | 346 (5.5%) | 125 (2.3%) | 254 (2.5%) | < 0.001 | |||
| Heart failure, n (%) | 6802 (26.5%) | 1648 (44.1%) | 2603 (41.5%) | 1031 (18.6%) | 1520 (15.0%) | < 0.001 | |||
| Hyperlipidemia, n (%) | 10,327 (40.3%) | 1923 (51.5%) | 2925 (46.6%) | 2164 (39.1%) | 3315 (32.8%) | < 0.001 | |||
| Sleep apnea, n (%) | 2483 (9.7%) | 774 (20.7%) | 344 (5.5%) | 922 (16.7%) | 443 (4.4%) | < 0.001 | |||
| Peripheral vascular disease, n (%) | 3327 (13.0%) | 584 (15.6%) | 1110 (17.7%) | 536 (9.7%) | 1097 (10.9%) | < 0.001 | |||
| Cerebrovascular disease, n (%) | 3713 (14.5%) | 535 (14.3%) | 1047 (16.7%) | 679 (12.3%) | 1452 (14.4%) | < 0.001 | |||
| Dementia, n (%) | 712 (2.8%) | 75 (2.0%) | 250 (4.0%) | 63 (1.1%) | 324 (3.2%) | < 0.001 | |||
| Chronic pulmonary disease, n (%) | 6341 (24.7%) | 1184 (31.7%) | 1774 (28.3%) | 1380 (25.0%) | 2003 (19.8%) | < 0.001 | |||
| Rheumatic disease, n (%) | 848 (3.3%) | 140 (3.8%) | 263 (4.2%) | 138 (2.5%) | 307 (3.0%) | < 0.001 | |||
| Peptic ulcer, n (%) | 698 (2.7%) | 105 (2.8%) | 163 (2.6%) | 126 (2.3%) | 304 (3.0%) | 0.052 | |||
| Liver disease, n (%) | 3080 (12.0%) | 414 (11.1%) | 505 (8.0%) | 867 (15.7%) | 1294 (12.8%) | < 0.001 | |||
| Diabetes, n (%) | 7543 (29.4%) | 1673 (44.8%) | 1652 (26.3%) | 2016 (36.5%) | 2202 (21.8%) | < 0.001 | |||
| Paraplegia, n (%) | 1152 (4.5%) | 143 (3.8%) | 274 (4.4%) | 223 (4.0%) | 512 (5.1%) | 0.002 | |||
| Renal disease, n (%) | 4957 (19.3%) | 1110 (29.7%) | 1627 (25.9%) | 852 (15.4%) | 1368 (13.5%) | < 0.001 | |||
| Cancer, n (%) | 3044 (11.9%) | 354 (9.5%) | 811 (12.9%) | 580 (10.5%) | 1299 (12.9%) | < 0.001 | |||
| Aids, n (%) | 151 (0.6%) | 2 (0.1%) | 14 (0.2%) | 24 (0.4%) | 111 (1.1%) | < 0.001 | |||
| Laboratory data | |||||||||
| White blood cell, k/ul | 10.9 (7.8–15.0) | 11.7 (8.4–16.1) | 10.9 (7.8–14.9) | 11.4 (8.1–15.5) | 10.5 (7.5–14.5) | < 0.001 | |||
| Hemoglobin, g/dl | 10.6 (9.0-12.2) | 10.3 (8.9–12.0) | 10.1 (8.7–11.7) | 11.0 (9.3–12.6) | 10.7 (9.2–12.3) | < 0.001 | |||
| Hematocrit, % | 31.9 (27.4–36.6) | 31.4 (27.2–36.2) | 30.8 (26.4–35.3) | 33.0 (28.3–37.7) | 32.2 (27.8–36.9) | < 0.001 | |||
| Platelet, k/ul | 182.0 (132.0-244.0) | 178.0 (134.0-235.0) | 167.0 (123.0-228.0) | 192.0 (141.5-253.5) | 186.0 (133.0-251.0) | < 0.001 | |||
| Urea nitrogen, mg/dl | 18.0 (13.0–28.0) | 22.0 (15.0–36.0) | 21.0 (15.0–33.0) | 17.0 (12.0–26.0) | 16.0 (11.0–24.0) | < 0.001 | |||
| Serum creatinine, mg/dl | 0.9 (0.7–1.3) | 1.1 (0.8–1.7) | 1.0 (0.7–1.5) | 0.9 (0.7–1.3) | 0.9 (0.7–1.2) | < 0.001 | |||
| Glucose, mg/dl | 0.8 (0.6-1.0) | 0.8 (0.7–1.1) | 0.8 (0.6-1.0) | 0.7 (0.6-1.0) | 0.7 (0.5–0.9) | < 0.001 | |||
| Sodium, mEq/L | 125.0 (104.0-157.0) | 131.0 (109.0-168.0) | 124.0 (103.0-152.0) | 131.0 (107.0-166.0) | 121.0 (102.0-152.0) | < 0.001 | |||
| Calcium, mg/dL | 139.0 (136.0-141.0) | 139.0 (136.0-141.0) | 139.0 (136.0-141.0) | 139.0 (136.0-141.0) | 139.0 (136.0-141.0) | 0.578 | |||
| Potassium, mEq/L | 8.3 (7.9–8.8) | 8.4 (7.9–8.8) | 8.3 (7.9–8.7) | 8.3 (7.9–8.8) | 8.3 (7.8–8.8) | < 0.001 | |||
| Chloride, mEq/L | 4.1 (3.8–4.6) | 4.3 (3.9–4.7) | 4.2 (3.8–4.6) | 4.2 (3.8–4.6) | 4.1 (3.7–4.5) | < 0.001 | |||
| Bicarbonate, mEq/L | 105.0 (101.0-109.0) | 105.0 (101.0-108.0) | 106.0 (101.0-110.0) | 105.0 (101.0-108.0) | 105.0 (102.0-109.0) | < 0.001 | |||
| Aniongap, mEq/L | 23.0 (21.0–25.0) | 23.0 (21.0–26.0) | 23.0 (20.0–25.0) | 23.0 (21.0–25.0) | 23.0 (20.0–25.0) | < 0.001 | |||
| Interventions | |||||||||
| Mechanical ventilation, n (%) | 12,566 (49.0%) | 1951 (52.2%) | 3244 (51.7%) | 2753 (49.8%) | 4618 (45.7%) | < 0.001 | |||
| CRRT, n (%) | 1119 (4.4%) | 291 (7.8%) | 325 (5.2%) | 244 (4.4%) | 259 (2.6%) | < 0.001 | |||
| Medications | |||||||||
| Antiplatelets, n (%) | 14,376 (56.0%) | 2632 (70.5%) | 4452 (70.9%) | 2693 (48.7%) | 4599 (45.5%) | < 0.001 | |||
| Lipid lowering drugs, n (%) | 12,995 (50.7%) | 2452 (65.7%) | 3814 (60.7%) | 2623 (47.4%) | 4106 (40.6%) | < 0.001 | |||
| Oral anticoagulants, n (%) | 7133 (27.8%) | 1951 (52.2%) | 3034 (48.3%) | 869 (15.7%) | 1279 (12.7%) | < 0.001 | |||
| Beta-blockers, n (%) | 17,636 (68.8%) | 3166 (84.8%) | 5282 (84.1%) | 3466 (62.7%) | 5722 (56.6%) | < 0.001 | |||
| DHP CCB, n (%) | 5558 (21.7%) | 876 (23.5%) | 1384 (22.0%) | 1270 (23.1%) | 2028 (20.1%) | < 0.001 | |||
| Non-DHP CCB, n (%) | 2557 (10.0%) | 799 (21.4%) | 1254 (20.0%) | 222 (4.0%) | 282 (2.8%) | < 0.001 | |||
| Class IC Antiarrhythmic drugs, n (%) | 93 (0.4%) | 40 (1.1%) | 42 (0.7%) | 2 (0.0%) | 9 (0.1%) | < 0.001 | |||
| Class III Antiarrhythmic drugs, n (%) | 4411 (17.2%) | 1501 (40.2%) | 2469 (39.3%) | 154 (2.8%) | 287 (2.8%) | < 0.001 | |||
| Digoxin, n (%) | 1235 (4.8%) | 392 (10.5%) | 752 (12.0%) | 24 (0.4%) | 67 (0.7%) | < 0.001 | |||
| ACEI, n (%) | 6447 (25.1%) | 1108 (29.7%) | 1772 (28.2%) | 1404 (25.4%) | 2163 (21.4%) | < 0.001 | |||
| ARB, n (%) | 1969 (7.7%) | 424 (11.4%) | 546 (8.7%) | 477 (8.6%) | 522 (5.2%) | < 0.001 | |||
| ARNI, n (%) | 37 (0.1%) | 8 (0.2%) | 14 (0.2%) | 7 (0.1%) | 8 (0.1%) | 0.070 | |||
| MRA, n (%) | 1318 (5.1%) | 289 (7.7%) | 296 (4.7%) | 322 (5.8%) | 411 (4.1%) | < 0.001 | |||
| Loop diuretics, n (%) | 15,680 (61.1%) | 2985 (79.9%) | 4659 (74.2%) | 3264 (59.0%) | 4772 (47.2%) | < 0.001 | |||
| Thiazides/thiazide-like diuretics, n (%) | 2605 (10.2%) | 632 (16.9%) | 684 (10.9%) | 641 (11.6%) | 648 (6.4%) | < 0.001 | |||
| Oral glucose-lowering drugs, n (%) | 2003 (7.8%) | 446 (11.9%) | 423 (6.7%) | 595 (10.8%) | 539 (5.3%) | < 0.001 | |||
| Insulin, n (%) | 17,534 (68.4%) | 2962 (79.3%) | 4514 (71.9%) | 3853 (69.7%) | 6205 (61.4%) | < 0.001 | |||
| PPIs, n (%) | 13,160 (51.3%) | 2054 (55.0%) | 3420 (54.5%) | 2863 (51.8%) | 4823 (47.7%) | < 0.001 | |||
| Inotropes and vasopressors, n (%) | 13,917 (54.3%) | 2470 (66.1%) | 4052 (64.5%) | 2710 (49.0%) | 4685 (46.3%) | < 0.001 | |||
| Outcomes | |||||||||
| ICU mortality | 1983 (7.7%) | 317 (8.5%) | 635 (10.1%) | 351 (6.4%) | 680 (6.7%) | < 0.001 | |||
| In-Hospital mortality | 2688 (10.5%) | 423 (11.3%) | 866 (13.8%) | 455 (8.2%) | 944 (9.3%) | < 0.001 | |||
| 6-month mortality | 5289 (20.6%) | 752 (20.1%) | 1799 (28.7%) | 832 (15.0%) | 1906 (18.9%) | < 0.001 | |||
| 1-year mortality | 6293 (24.5%) | 925 (24.8%) | 2094 (33.4%) | 985 (17.8%) | 2289 (22.6%) | < 0.001 | |||
AF: atrial fibrillation; APS III: Acute Physiologic Score III; LODS: Logistic Organ Dysfunction Score; OASIS: the Oxford Acute Severity of Illness Score; SAPS II: Simplified Acute Physiology Score II; SIRS: Systemic Inflammatory Response Syndrome; SOFA: Sequential Organ Failure Assessment; CRRT: continuous renal replacement therapy; DHB CCB: dihydropyridine calcium channel blocker; Non-DHB: non- dihydropyridine; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin-receptor blocker; ARNI: angiotensin receptor-neprilysin inhibitor; MRA: mineralocorticoid receptor antagonist; PPI: proton pump inhibitors; ICU: intensive care unit
*Comparisons among the four subgroups