ASSOCIATION OF ACUTE HEART FAILURE AND FEMORAL FRACTURES: A PROPENSITY-WEIGHTED ANALYSIS OF NATIONAL INPATIENT SAMPLE

Abstract

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Heart failure in the setting of acute trauma is poorly understood. Associated large scale catecholamine surge is known to have a multitude of effects on the cardiovascular system. At our level 1 trauma center, we attempted to better characterize the correlation between acute heart failure and femoral fractures. METHODS: A composite database of National Inpatient Sample (NIS) for 2016 and 2017 was queried using ICD-10 codes to identify patients with femur fracture among a cohort of patients with acute heart failure. A propensity weighted logistic regression analysis was performed controlling for age, gender, and comorbidities. Propensity weighted cohorts were compared for correlation with acute HF [in each category of acute HF (acute, acute on chronic) and HF subtype (systolic, diastolic, combined systolic/diastolic, right heart, and takotsubo cardiomyopathy)]. RESULTS: Among a cohort of 815,899 patients with acute heart failure, a total of 3,792 patients were identified with a concurrent diagnosis of femoral fracture. Population average age was 82.19+8.8 years, 63.58% of whom were female. A propensity weighted logistic regression model using each acute heart failure subtype as a dependent variable was performed using Stata 16.1 controlling for age, gender, and comorbidity (presence of AICD, Pacemaker, history of chronic heart failure, diabetes, ischemic stroke, COPD, PVD, CKD, OSA, hypertension, CAD). Acute diastolic heart failure [OR 1.578, 95% CI(1.278-1.947), p < 0.001] and takotsubo cardiomyopathy [OR 2.041, 95% CI(1.622-2.567), p < 0.001] were found to have a strong positive correlation to femoral fracture. CONCLUSIONS: In our study, we focused on the comparison of patients with acute heart failure and the propensity for concurrent femoral fracture. A strong positive correlation with acute diastolic heart failure and takotsubo cardiomyopathy was found with femoral fractures. Patients with heart failure should be considered at higher risk for femoral fracture than the average healthy population. The increased risk can be attributed to comorbid conditions as well as the intrinsic risk posed by the pathophysiology of HF itself. Hip fractures may be an important, yet underreported contributor of mortality in HF patients. CLINICAL IMPLICATIONS: Patients with femoral fracture should be monitored closely for acute heart failure. DISCLOSURES: No relevant relationships by Krishna Akella, source=Web Response No relevant relationships by Charles Arcoleo, source=Web Response No relevant relationships by Akella Chendrasekhar, source=Web Response No relevant relationships by Priscilla Chow, source=Web Response No relevant relationships by Kashif Hussain, source=Web Response No relevant relationships by Samer Ibrahim, source=Web Response No relevant relationships by Gunjan Joshi, source=Web Response No relevant relationships by Ghulam Mujtaba, source=Web Response No relevant relationships by Rajoo Patel, source=Web Response No relevant relationships by Heidi Roppelt, source=Web Response No relevant relationships by Nandini Seshan, source=Web Response No relevant relationships by Howard Sklarek, source=Web Response No relevant relationships by Liana Tatarian, source=Web Response No relevant relationships by Daisy Young, source=Web Response