Abstract 13743: Prevalence of Cardiac Rhythm Disturbances in Heart Failure Patients With and Without Cardiac Amyloidosis: A National Inpatient Sample Analysis

Abstract

Background: Cardiac amyloidosis (CA) is well-known to affect electrocardiographic findings. However, the impact of CA on the prevalence of cardiac arrhythmias, particularly in heart failure (HF) patients, is unknown. Our aim was to assess the prevalence of arrhythmias in HF patients with and without CA. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2017. About 5,074,059 patients who had acute, acute on chronic and chronic HF as primary or secondary diagnosis were identified and stratified based on the presence or absence of CA using ICD-10 codes. Both univariate regression and literature review were used to determine the covariates. Multivariate logistic regression analysis was used to adjust for confounders and analyze the variables. Results: Out of the 5,074,059 hospitalized patients with a primary and secondary diagnosis of HF, 7,980 individuals had CA. HF patients with CA had a higher prevalence of Atrial Fibrillation (AF) (52.6% vs 39.3%), Atrial Flutter (AFL) (9.4% vs 3.89%), Ventricular tachycardia (VT) (9.6% vs 4%), Supraventricular tachycardia (SVT) (3.9% vs 2.1%), right bundle branch block (RBBB) (2.9% vs 1.6%), 1st degree AV block (1AVB) (3.07% vs 1%), 2nd degree AV block (2AVB) (1.4% vs 0.4%), and 3rd degree AV block (3AVB) (1.25% vs 0.7%) than without. When adjusted to patient demographics, comorbidities, and hospital characteristics, HF patients with CA had higher risk of AF (aOR= 1.67, p<0.0001), AFL (aOR=2.9, p<0.0001), VT (aOR=2.08, p<0.0001), SVT (aOR=1.63, p<0.0001), RBBB (aOR=1.62, p=0.002), 1AVB (aOR=2.27, p<0.0001), and 2AVB (aOR=2.86, p<0.0001) compared to those without. However, there was no significant difference in the prevalence of Ventricular Fibrillation (VF) (aOR=0.92, p=0.82) in the same population. Conclusion: HF patients with CA are 67%, 190%, 108%, 63%, 62%, 127%, and 186% more likely to develop AF, AFL, VT, SVT, RBBB, 1AVB, and 2AVB respectively, than those without. However, HF patients with CA did not have a significant difference in the prevalence of VF, 3AVB, and LBBB. CA is an infiltrative disease process that is known to cause cardiac conduction disturbances. Limitations include the underdiagnosis of CA in our society as well as the non-specificity of ICD codes for CA.