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Atrial fibrillation (AF) is associated with increased hospitalization.  Objectives: We aimed to compare long-term outcomes in patients with AF hospitalized in academic and district hospitals.  Patients and methods: This retrospective observational study included data from the Multicenter Experience in Atrial Fibrillation Patients Treated with Oral Anticoagulants (CRAFT; NCT02987062) study which included AF patients hospitalized between 2011 and 2016 in academic and district hospitals. The primary end point was a major adverse event (MAE) defined as all-cause death and thromboembolic and hemorrhagic events during the median 4-year follow-up.  Results: We analyzed 2983 patients with AF: 2271 (76%) from academic and 712 (24%) from district hospitals. Patients treated in district hospitals, as compared with patients treated in academic hospitals, more often experienced MAEs (53% vs 37%; P &lt;⁠0.001), all-cause death (40% vs 24%; P &lt;⁠0.001), and thromboembolic events (13% vs 7.8%; P &lt;⁠0.001), with similar rates of hemorrhagic events (15% vs 15%; P = 1.00). In multivariable logistic regression, female sex, coronary artery disease, smoking, and antiplatelet drug therapy were associated with greater likelihood of thromboembolic events in academic hospitals. Heart failure, renal failure, and vitamin K antagonist (in academic hospitals), and coronary artery disease (in district hospitals) were associated with greater likelihood of hemorrhagic events. District (vs academic) conditions were associated with higher risk of MAEs and all-cause death in men and those with low risk of bleeding, and with higher incidence of thromboembolic events in women, elderly patients, and those with high risk of bleeding and with diabetes.  Conclusions: Patients with AF treated at district hospitals had worse long-term outcomes than those treated in academic conditions.

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District versus academic hospital – clinical outcomes of patients with atrial fibrillation. MultiCenter expeRience in Atrial Fibrillation Patients Treated With Oral Anticoagulants (CRAFT) study