ACUTE PULMONARY EMBOLISM IN PATIENTS WITH UNDERLYING HEART FAILURE

Abstract

SESSION TITLE: Expanding Considerations in Management of Pulmonary EmbolismSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: It has been reported that acute pulmonary embolism (PE) carries higher mortality rate in patients with underlying heart failure. In this study, we aimed to investigate the impact of acute PE on patients with underlying heart failure utilizing NIS database. Outcomes of interest are mortality, mechanical ventilation, vasopressors use, cardiac arrest, ICU admission, total hospital charges, and length of stay.METHODS: We conducted a retrospective study utilizing NIS database from 2016 to 2019. Patients with acute PE and heart failure were determined using clinical Modification/Procedure Coding System (ICD-10). We compared patients with underlying heart failure to those with normal cardiac function who presented to the hospital with acute PE in terms of mortality, mechanical ventilation, vasopressors use, cardiac arrest, ICU admission, total hospital charges, and length of stay.RESULTS: There were 142 million discharges included in the NIS database between 2016-2019, of which 1,294,039 met the inclusion criteria. No significant difference in mortality was found in patients with heart failure compared to those without heart failure who presented with acute PE with odds ratio of 1.060 (25% CI 0.992 to 1.133, P-value= 0.086). Mechanical ventilation, vasopressors use, cardiac arrest and ICU admission were higher in patients with heart failure compared to those with normal cardiac function who presented with acute PE with odds ratio of 1.474 (95% CI 1.389 to 1.566, P-value= 0.000), 1.835 (95% CI 1.627 to 2.069, P-value= 0.000), 1.871 (95% CI 1.735 to 2.016, P value= 0.000) and 1.537 (95% CI 1.451 to 1.628, P value= 0.000), respectively. We also found that patients with heart failure compared to those with normal cardiac function who presented with acute PE to have longer hospital stay, and increased total hospital charges (in dollars) with coefficient of 1.192 (95% CI, 1.009 to 1.374, P-value 0.000) and 21558.7 (95% CI, 18016.4 to 25101.0, P-value 0.000), respectively.CONCLUSIONS: Our study suggests no difference in mortality between patients with heart failure and normal cardiac function who present with acute PE. However, mechanical ventilation, vasopressors use, cardiac arrest and ICU admission, hospital length of stay and total hospital charges were higher in the heart failure group compared to the group with normal cardiac function who presented with acute PE.CLINICAL IMPLICATIONS: Acute PE might not increase the mortality risk in patients with underlying heart failure. However, those patients might require higher level of care and longer hospital stay which in turn might increase the risk of morbidity significantly. Further studies are required to investigate the effect of acute PE on patients with heart failure to dictate the best treatment plan and guide triaging to the appropriate level of care.DISCLOSURES: No relevant relationships by Louay AldabainNo relevant relationships by Mohammad DarweeshNo relevant relationships by Metri HaddadenNo relevant relationships by Ratib MahfouzNo relevant relationships by Mahmoud MansourNo relevant relationships by Adham Obeidat SESSION TITLE: Expanding Considerations in Management of Pulmonary Embolism SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: It has been reported that acute pulmonary embolism (PE) carries higher mortality rate in patients with underlying heart failure. In this study, we aimed to investigate the impact of acute PE on patients with underlying heart failure utilizing NIS database. Outcomes of interest are mortality, mechanical ventilation, vasopressors use, cardiac arrest, ICU admission, total hospital charges, and length of stay. METHODS: We conducted a retrospective study utilizing NIS database from 2016 to 2019. Patients with acute PE and heart failure were determined using clinical Modification/Procedure Coding System (ICD-10). We compared patients with underlying heart failure to those with normal cardiac function who presented to the hospital with acute PE in terms of mortality, mechanical ventilation, vasopressors use, cardiac arrest, ICU admission, total hospital charges, and length of stay. RESULTS: There were 142 million discharges included in the NIS database between 2016-2019, of which 1,294,039 met the inclusion criteria. No significant difference in mortality was found in patients with heart failure compared to those without heart failure who presented with acute PE with odds ratio of 1.060 (25% CI 0.992 to 1.133, P-value= 0.086). Mechanical ventilation, vasopressors use, cardiac arrest and ICU admission were higher in patients with heart failure compared to those with normal cardiac function who presented with acute PE with odds ratio of 1.474 (95% CI 1.389 to 1.566, P-value= 0.000), 1.835 (95% CI 1.627 to 2.069, P-value= 0.000), 1.871 (95% CI 1.735 to 2.016, P value= 0.000) and 1.537 (95% CI 1.451 to 1.628, P value= 0.000), respectively. We also found that patients with heart failure compared to those with normal cardiac function who presented with acute PE to have longer hospital stay, and increased total hospital charges (in dollars) with coefficient of 1.192 (95% CI, 1.009 to 1.374, P-value 0.000) and 21558.7 (95% CI, 18016.4 to 25101.0, P-value 0.000), respectively. CONCLUSIONS: Our study suggests no difference in mortality between patients with heart failure and normal cardiac function who present with acute PE. However, mechanical ventilation, vasopressors use, cardiac arrest and ICU admission, hospital length of stay and total hospital charges were higher in the heart failure group compared to the group with normal cardiac function who presented with acute PE. CLINICAL IMPLICATIONS: Acute PE might not increase the mortality risk in patients with underlying heart failure. However, those patients might require higher level of care and longer hospital stay which in turn might increase the risk of morbidity significantly. Further studies are required to investigate the effect of acute PE on patients with heart failure to dictate the best treatment plan and guide triaging to the appropriate level of care. DISCLOSURES: No relevant relationships by Louay Aldabain No relevant relationships by Mohammad Darweesh No relevant relationships by Metri Haddaden No relevant relationships by Ratib Mahfouz No relevant relationships by Mahmoud Mansour No relevant relationships by Adham Obeidat