Associations Between Adrenal Insufficiency and Cardiovascular Outcomes in Patients Hospitalized with Takotsubo Cardiomyopathy: Insights from the Nationwide Readmissions Database (2019)

Relationships between adrenal insufficiency and cardiovascular outcomes in patients with congestive heart failure.

Relationships between adrenal insufficiency and cardiovascular outcomes in patients with atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardia

Introduction: Takotsubo, or stress cardiomyopathy, can result in substantial morbidity and mortality. Malnutrition can affect the prognosis of hospitalized patients. Objective: To compare Takotsubo cardiomyopathy outcomes between patients with severe protein-calorie and mild-moderate malnutrition. Methods: We queried the National Inpatient Sample (NIS) from 2016 to 2020 for adults hospitalized with Takotsubo cardiomyopathy and severe or mild-moderate protein-calorie malnutrition. The primary outcome was inpatient mortality. Secondary outcomes included cardiac arrest, cardiogenic shock, respiratory failure/mechanical ventilation, acute kidney injury, vasopressor use, palliative consult, length of stay (LOS), and total hospital charges (TOTCHG). Multivariate logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: Among 159,395 patients with Takotsubo cardiomyopathy, 10,638 had severe protein-calorie malnutrition, while 5,907 had mild-moderate malnutrition. Respectively, the groups had mean age 67 vs. 68 years, male sex 27.0% vs. 24.8%, and White race 76.5% vs. 78.6% (Table 1A). Compared to the mild-moderate malnutrition group, the severe malnutrition group had higher odds of in-hospital mortality [OR 1.53, CI (1.12-2.07), P=0.006], palliative consults [OR 1.74 CI (1.29-2.34) P<0.0001], longer LOS (15 vs. 13 days), and higher charges ($215,441 vs. $188,171) (Table 1B). Other outcomes showed no significant differences. Conclusion: In patients with Takotsubo cardiomyopathy, severe protein-calorie malnutrition significantly worsens clinical outcomes.

BackgroundPatients with Systemic Lupus Erythematosus (SLE) face a higher risk of cardiovascular morbidity, but data on Right Heart Failure (RHF) in-hospital outcomes in the context of SLE remain limited. Using a nationwide hospitalization database, we assess the impact of SLE on cardiovascular outcomes in cases of RHF.MethodsRHF cases were queried from the 2016-2019 National Inpatient Sample, comparing outcomes between those with vs. without SLE. Primary outcome included all-cause mortality while secondary outcomes included vasopressor use, acute kidney injury (AKI), mechanical ventilation use, hospital length of stay (LOS), and total hospitalization charges (THC). Multivariable and linear regression models adjusted for confounders including patient demographics and comorbidity burden.ResultsOf 5,569 RHF hospitalizations, 2% (111) involved SLE. SLE was associated with higher mortality (adjusted OR [aOR] 3.8, 95% CI 1.19-12.29), AKI (aOR 2.61, 95% CI 1.05-6.52), vasopressor use (aOR 8.11, 95% CI 2.20-29.8). No differences were observed regarding odds of mechanical ventilation use (aOR 1.39, 95% CI 0.35-5.5), mean LOS (7.3 vs 6.5 days, p = .436) or THC ($258,475 vs $86,910, p = .301) between both groups.ConclusionAmong RHF hospitalizations SLE is associated with higher mortality and non-fatal adverse outcomes. Further studies are necessary to confirm these findings and to clarify mechanisms aimed at improving outcomes for SLE patients hospitalized with RHF.

Introduction: There is limited data describing the cardiovascular outcomes in patients with coronavirus 2019 (COVID-19) and chronic kidney disease (CKD). This study aims to investigate the impact of CKD on cardiovascular outcomes in patients hospitalized with COVID-19. Goals: To assess mortality, readmission, and other in-hospital cardiovascular outcomes in COVID-19 patients with and without CKD. Methods: Patients >18 years hospitalized with a diagnosis of COVID-19 were identified in the 2020 National Readmissions Database. Patients with CKD 3, 4 and 5 were subsequently identified using relevant ICD-10 codes. Nearest propensity score matching was conducted using a 1:1 ratio for several demographic, social, and clinical variables. Outcomes with <10 cases were excluded per HCUP rules. Results: Amongst 5,831 COVID-19 patients identified, 599 had either CKD stage 3, 4 or 5. Baseline characteristics are shown in Table 1. After matching, CKD was associated with higher rates of acute heart failure (HF) and acute kidney injury (AKI). Our analysis did not find any significant differences in mortality or readmission rates. Conclusions: Our analysis found a higher rate of Acute HF and AKI among COVID-19 patients with CKD 3-5 compared to those without CKD. Additional studies are needed to further characterize this observation.

Background: There is a growing body of data to support the presence of sex disparities in outcomes in cardiovascular related hospitalizations. Despite this, there remains a paucity of data on relationships between sex and in-hospital outcomes in cases of Complete Heart Block (CHB). Methods: We examined the 2016-2020 Nationwide Readmission Database (NRD) to identify patients with a principal diagnosis of CHB. Men were used as our control group, while women comprised our cohort. The primary outcome was in-patient mortality. Secondary outcomes included odds of mechanical ventilation use, all cause 30-day readmission, length of stay (LOS) and total hospitalization charges (THC). Multivariate linear and logistic regression models were used to adjust for confounders. Results: Among the patients with CHB (N = 175,257), 45% were Female. A Female sex was associated with higher odds of in-hospital mortality (adjusted OR [aOR] 1.42, 95% CI 1.3 – 1.55, p<0.001) compared to male patients with CHB. Additionally, female sex was associated with a higher likelihood of mechanical ventilation use (aOR 1.1, 95% CI 1.03 – 1.2, p=0.004), all cause 30-day readmission (aOR 1.08, 95% CI 1.03 – 1.13, p=0.004), longer LOS (4.13 days vs 3.86 days, p<0.001) and lower THC ($89,908 vs. $94,590, p=0.002) compared to male patients with CHB. Conclusion: Among patients with CHB, female sex was associated with higher odds of mortality, non-fatal adverse events, and lower resource utilization compared to male patients.

Funding Acknowledgements Type of funding sources: None. 1. Background Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are indicated in primary and secondary prevention of dysrhythmias among other indications. We sought to determine the impact of chronic kidney disease (CKD) on hospitalizations for ICD or CRT-D placement. 2. Purpose Determine how CKD impacts in-patient mortality and cardiovascular outcomes in patients undergoing ICD or CRT-D placement while hospitalized. 3. Methods Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for patients who underwent ICD or CRT-D placement. The patients were divided into two groups based on presence or absence of CKD as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders (A univariate screen was done to confirm the confounders affected outcomes with variables having a p less than 0.2 were included in the multivariate regression analysis). STATA software was used to for analysis. 4. Results Of 145,550 patients admitted for ICD or CRT-D placement, 47740 (32.8%) had CKD. The adjusted odds ratio (aOR) for inpatient mortality for patients undergoing ICD or CRT-D placement with co-morbid CKD compared to those without CKD was 1.66 (95% CI 1.194 – 2.329, p = 0.003). Patients with comorbid CKD had lower odds of developing cardiogenic shock (aOR: 0.83, 95% CI 0.718 – 0.948, p = 0.007) and cardiac arrest (aOR: 0.88, 95% CI 0.766 – 0.999, p = 0.048) compared to patients without CKD. Detailed outcomes are listed in table 1. 5. Conclusion Chronic kidney disease is a risk factor associated with increased in-patient mortality in patients admitted for ICD or CRT-D placement. Outcome Without CKD, % With CKD, % aOR (95% CI) p-value* Primary outcome In hospital mortality 0.6 1.9 1.66 (1.194 - 2.329) 0.003* Secondary outcomes Length of stay (days), mean 7.0 9.2 -0.01 (-0.345 - 0.322) # 0.945 Total hospital charges (US$), mean 218,962 241,679 -13047 (-20924 - -5171) # 0.001* Cardiogenic shock 6.8 8.0 0.83 (0.718 - 0.948) 0.007* IABP placement 1.7 1.7 0.52 (0.399 - 0.671) <0.001* Cardiac arrest 12..1 8.5 0.88 (0.766 - 0.999) 0.048* Acute renal failure 17.9 48.1 2.89 (2.648 - 3.163) <0.001* Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon placement.Adjusting factors: Age, Charlson comorbidity index, patient’s insurance, location and teaching status of the admitting hospital, dyslipidemia, old myocardial infarction, cerebral infarction, hypertension, diabetes mellitus, liver disease, smoking status and obesity.

Introduction: Coronavirus 19 (COVID-19) has rapidly emerged as a major contributor to hospitalizations and readmissions, with growing evidence emphasizing its correlation with adverse outcomes in heart failure (HF). This study aims to investigate the impact of COVID-19 on cardiovascular outcomes in patients hospitalized with HF. Goals: To assess the impact COVID-19 on mortality, readmissions, and other cardiovascular outcomes in HF patients. Methods: Patients >18 years hospitalized with a diagnosis of chronic HF and COVID-19 were identified in the 2020 National Readmissions Database. Nearest propensity matching (PSM) was conducted using a 1:1 ratio for demographic, social, and clinical variables. PSM was repeated for systolic and diastolic heart failure subgroups. Outcomes with <10 cases were excluded per HCUP rules. Results: Amongst the 1,922,680 CHF patients identified, 461 had COVID-19. Baseline characteristics are shown in Table 1. After matching, COVID-19 showed no significant impact on mortality, 30- and 90- day readmissions, acute myocardial infarction, or acute kidney injury (AKI). Interestingly, the subgroup analysis revealed that COVID-19 significantly reduced AKI in diastolic HF (Table 2). Conclusions: Patients with COVID-19 hospitalized with HF are not at a higher risk for mortality, readmissions, or other cardiovascular outcomes. Interestingly, a significant reduction in AKI was observed in diastolic HF patients with COVID-19, warranting further investigation.

Takotsubo cardiomyopathy (TCM) is an acute form of left-ventricular systolic dysfunction triggered by emotional or physical stress, which can lead to refractory cardiogenic shock. In such cases, mechanical cardiovascular support, such as extracorporeal membrane oxygenation (ECMO), may be beneficial. However, the outcomes of ECMO in this population remain unclear. To evaluate the association between ECMO and in-hospital outcomes in patients hospitalized with TCM and cardiogenic shock. We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2022 to evaluate outcomes in adult patients hospitalized with TCM and cardiogenic shock. ECMO use was identified using ICD-10 procedure codes. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), total hospital charges (THCs), acute kidney injury, and bleeding complications. Propensity score matching with double adjustment using survey-weighted logistic and linear regression was used to adjust for confounders. A total of 20 350 weighted hospitalizations were included, with 300 patients (1.5%) receiving ECMO. In the unadjusted analysis, ECMO was associated with higher in-hospital mortality (35.0 vs. 27.7%), longer LOS (19.4 vs. 12.1 days), and higher THCs ($761 206 vs. $254 690). After matching, 270 patients were identified in each group. ECMO was still associated with higher THCs ($630 317 vs. $372 195). In-hospital mortality remained higher in the ECMO group (32.5% vs. 26.7%), although not statistically significantly (P = 0.49). Among patients with TCM complicated by cardiogenic shock, ECMO was not associated with a significant reduction in mortality. Further studies are warranted to improve patient risk stratification and clarify the clinical value of ECMO in this population.

Introduction: Hypertension (HTN) is a co-morbidity that is commonly associated with heart failure (HF) with preserved ejection fraction (HFpEF). This meta-analysis aims to evaluate the association of anti-hypertensive medications (AHM) therapy with cardiovascular (CV) outcomes in patients with HFpEF. Hypothesis: Treatment of HTN in HFpEF patients is associated with improved CV outcomes. Methods: Performed a database search (OVID Medline, Web of Science, and Embase) for studies reporting the association of AHM with CV outcomes in patients with HFpEF. The primary endpoint was all-cause mortality. Secondary endpoints include CV mortality, worsening HF, CV hospitalization, and major adverse CV events (MACE). Results: A total of 15 studies with 17507 HFpEF participants (8732 treated with medical therapy vs 8775 treated with placebo) met inclusion criteria. Use of AHM was not associated with lower all-cause mortality or CV mortality compared to treatment with placebo (OR 1.01, 95% CI 0.80-1.27; p=0.95, OR 0.97, 95% CI 0.86-1.08; p=0.53). Use of AHM was associated with a statistically significant lower risk of MACE and CV hospitalization (OR 0.90, 95% CI 0.83-0.97; p<0.01, OR 0.89, 95% CI 0.81-0.97; p<0=0.04). Subgroup analysis demonstrated this to be primarily driven by studies with mixed HFpEF patients with or without HTN, not HFpEF patients with HTN. There was a non-significant trend toward lower risk of worsening HF in patients treated with AHM, and was driven by HFpEF patients with or without HTN, not HFpEF patients with HTN (OR 0.87, 95% CI 0.78-0.97; p=0.02 versus OR 0.57, 95% CI 0.18-1.86; p=0.35). Conclusion: While treatment with anti-hypertensives was not associated with lower risk of all-cause mortality, their use may be associated with reduced risk of adverse CV outcomes in patients with HFpEF regardless of whether they have HTN. Further studies are needed to clarify this association and determine the effect based on specific classes of medications.

EFFECT OF OSA IN ASPIRATION PNEUMONIA: ANALYSIS OF THE NATIONAL INPATIENT SAMPLE

Relationships between socioeconomic status and cardiovascular outcomes in patients with complete heart block

Comparison of Complications and In-Hospital Mortality in Takotsubo (Apical Ballooning/Stress) Cardiomyopathy Versus Acute Myocardial Infarction

ObjectiveTo evaluate the frequency of intra-abdominal hypertension in major burnpatients and its association with the occurrence of acute kidney injury.MethodsThis was a prospective cohort study of a population of burn patientshospitalized in a specialized intensive care unit. A convenience sample wastaken of adult patients hospitalized in the period from 1 August 2015 to 31October 2016. Clinical and burn data were collected, and serialintra-abdominal pressure measurements taken. The significance level used was5%.ResultsA total of 46 patients were analyzed. Of these, 38 patients developedintra-abdominal hypertension (82.6%). The median increase in intra-abdominalpressure was 15.0mmHg (interquartile range: 12.0 to 19.0). Thirty-twopatients (69.9%) developed acute kidney injury. The median time todevelopment of acute kidney injury was 3 days (interquartile range: 1 - 7).The individual analysis of risk factors for acute kidney injury indicated anassociation with intra-abdominal hypertension (p = 0.041), use ofglycopeptides (p = 0.001), use of vasopressors (p = 0.001) and use ofmechanical ventilation (p = 0.006). Acute kidney injury was demonstrated tohave an association with increased 30-day mortality (log-rank, p =0.009).ConclusionIntra-abdominal hypertension occurred in most patients, predominantly ingrades I and II. The identified risk factors for the occurrence of acutekidney injury were intra-abdominal hypertension and use of glycopeptides,vasopressors and mechanical ventilation. Acute kidney injury was associatedwith increased 30-day mortality.

Breast cancer is a major health concern with significant morbidity and mortality, especially in patients with cardiovascular events. Understanding its interaction with cardiovascular outcomes is essential for improving care. This study evaluates the association between breast cancer and cardiovascular outcomes, including mortality, cardiogenic shock, acute kidney injury, vasopressor use, transfusion needs, and other events in STEMI and NSTEMI patients. This study examines how breast cancer affects cardiovascular outcomes in STEMI and NSTEMI, assessing differences in mortality, cardiogenic shock, acute kidney injury, vasopressor use, transfusion needs, gastrointestinal bleeding, sepsis, cerebrovascular accident, intubation, cardiac arrest, and PCI and CABG rates. The goal is to determine potential protective or adverse effects. The objective is to evaluate the impact of breast cancer on cardiovascular events and interventions in STEMI and NSTEMI patients. Using a national inpatient dataset, this study quantifies outcome disparities, evaluates healthcare access, and informs cardiovascular care strategies for breast cancer patients. A multiyear retrospective analysis of the National Inpatient Sample (2017–2022) was conducted. Logistic regression models examined associations between breast cancer and cardiovascular outcomes. Patients were stratified by STEMI and NSTEMI, adjusting for demographics, socioeconomic status, hospital region, and comorbidities. Outcomes included mortality, cardiogenic shock, acute kidney injury, vasopressor use, transfusions, gastrointestinal bleeding, sepsis, cerebrovascular accident, intubation, cardiac arrest, PCI, and CABG. In STEMI patients, breast cancer was associated with lower mortality, cardiogenic shock, acute kidney injury, vasopressor use, transfusion, gastrointestinal bleeding, sepsis, cerebrovascular accident, intubation, and higher PCI use. In NSTEMI patients, breast cancer was linked to lower mortality, acute kidney injury, vasopressor use, transfusion, gastrointestinal bleeding, sepsis, cerebrovascular accident, intubation, and higher PCI use. Breast cancer patients with STEMI and NSTEMI had fewer adverse cardiovascular outcomes and were more likely to receive PCI, likely due to increased healthcare interactions. Enhanced surveillance and access to care may explain these better outcomes. Further research should explore healthcare access and treatment factors influencing cardiovascular health in this population.