Abstract
ObjectiveThis study aimed to determine the differences in hospitalization outcomes among patients admitted for congestive cardiac failure (CCF) with underlying subclinical hypothyroidism (SCH).MethodsThis retrospective case-control study used data from the nationwide inpatient sample (NIS) for the years 2012–2014. We identified cases with CCF as the primary diagnosis and SCH as the secondary diagnosis using validated ICD-9-CM codes and controls with CCF only. The differences in hospitalization outcomes and hospital characteristics were quantified using the multinomial logistic regression model (adjusted odds ratio (aOR)).ResultsA total of 143,735 CCF patients were enrolled in this study, and 73,440 cases had IH. About 31.8% of SCH patients were hospitalized for more than four days (median) compared to 44.7% patients without SCH (P < .001). The median hospitalization charges per admission for CCF was $20,312. CCF patients with SCH had lower odds of longer hospitalization (aOR = .709, 95% CI .660-.762, P < .001) and higher hospitalization charges (aOR = .783, 95% CI .728-.841, P < .001) compared to CCF patients without SCH. CCF patients with SCH had two times higher odds of minor morbidity (aOR = 2.276; 95% CI 2.105-2.462; P < .001) but lower odds of major morbidity (aOR = .783; 95% CI .728-.841; P < .001). Inpatient mortality with SCH patients (2%) compared to 3.6% patients without SCH (P < .001). CCF patients with SCH had lower odds of in-hospital mortality (aOR = .547; 95% CI .496-.604; P < .001). CCF patients with SCH had higher odds of being seen in rural non-teaching hospitals (aOR = 1.696; 95% CI 1.572-1.831; P < .001). Also, CCF patients with SCH had the highest likelihood of presence in the western region of the United States (aOR = 149.924; 95% CI 110.497-203.419; P < .001) followed by the southern region (aOR = 31.431; 95% CI 26.066-37.900; P < .001).ConclusionsAmong CCF with SCH patients during hospitalization, we observed a variation in hospitalization outcomes, including inpatient length of stay and cost, morbidity, and in-hospital mortality. We found no significant increase in mortality and major morbidity in CCF patients with SCH. There were differences in the hospital characteristics between CCF patients with and without SCH. Thus, hospital bed size, location, and teaching status act as predictors for a co-diagnosis of SCH in CCF. Further research is needed to guide the development of clinical care models for targeting early diagnosis and treatment to determine whether thyroid hormone replacement would be beneficial for CCF patients with SCH and improve quality of care in these patients.
Highlights
Subclinical hypothyroidism (SCH) is a condition in which an elevated serum thyrotropin level (TSH) is present in combination with the normal range of serum free T4 level
The median hospitalization charges per admission for cardiac failure (CCF) was $20,312
CCF patients with subclinical hypothyroidism (SCH) had the highest likelihood of presence in the western region of the United States followed by the southern region
Summary
Subclinical hypothyroidism (SCH) is a condition in which an elevated serum thyrotropin level (TSH) is present in combination with the normal range of serum free T4 level. This condition occurs in 3% to 8% of the general population. The occurrence of subclinical hypothyroidism varies among people, with a higher incidence associated with increasing age, female sex, and iodine deficiency [1,2]. There is little evidence of the clinical importance and therapy (levothyroxine) for treating subclinical hypothyroidism with a mild elevation of serum TSH (
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