Abstract 16766: Increased Clinical and Financial Burden of Heart Failure Hospitalizations in Patients With Systemic Lupus Erythematosus: Insights From the National Inpatient Sample 2012-2014

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease associated with increased cardiovascular (CV) co-morbidities. Recent evidence suggests that (SLE) is associated with higher incidence of heart failure (HF) independent of traditional CV risk factors. Despite a known association with accelerated CV diseases, the association between burden of acute decompensated HF (ADHF) and SLE is not well-characterized. Therefore, we used a large national database to examine the clinical and financial burden of ADHF in SLE. Hypothesis: SLE would associate with increased hospitalization for ADHF along with a longer length of stay (LOS) and higher hospital charges. Methods: SLE patients (n=160,350) older than 18 years were identified in the Nationwide Inpatient Sample (NIS) 2012-2014 databases using the ICD-9 code 710.0. ADHF was classified using appropriate ICD-9 codes from 428.0-428.9. Demographics, traditional CV risk factors, and HF-related outcomes were defined in SLE patients and compared to the general population. Results: Patients in the general population and with SLE were middle-aged (median 56 and 59 years). Prevalence of hypertension and chronic kidney disease was higher in SLE patients, whereas diabetes, coronary artery disease, dyslipidemia was lower (Table 1). ADHF rate, LOS and total hospital charges were increased in SLE. Furthermore, LOS (standardized β=0.003, p<0.001) and hospital charges (β=0.006, p<0.001) were associated with SLE beyond CV risk factors. Finally, after adjustment for CV risk factors (age, sex, hypertension, diabetes, dyslipidemia, coronary artery disease, chronic kidney disease, smoking), dysrhythmias, thyroid disorders, alcohol use and median household income, SLE associated with ADHF (OR, 95% CI: 1.53 [1.51-1.55], p<0.001), increased LOS (1.14 [1.11-1.17], p<0.001) and increased hospital charges (1.12 [1.09-1.15], p<0.001) (Table 1). Conclusion: SLE is associated with increased clinical and financial burden of ADHF beyond CVRF, underscoring the need for greater early clinical awareness of SLE in HF patients. Larger prospective studies are needed to confirm our findings.