Effect of Malnutrition on Outcomes of Patients Hospitalized for Implantable Cardioverter-Defibrillator Implantation

Abstract

Background: Implantable cardioverter-defibrillator (ICD) implantation is an invasive procedure that is associated with potential morbidity and mortality. Frail hospitalized older adults who are malnourished are potentially more susceptible. Quantifying the risk and benefit of ICD in different susceptible group is of interest to prevent inappropriate placement and assist with clinician-decision making. Objective: To examine the impact of protein energy malnutrition (PEM) on patients hospitalized for ICD placement. Methods: Data for this study was obtained from the combined Nationwide Inpatient Sample (NIS) 2016-2017. Primary outcome was inpatient all-cause mortality. Length of hospitalization (LOS), total hospital charges (THC), postprocedural complications (PPC), acute renal failure (ARF), and cerebrovascular accidents (CVA) were among the secondary outcomes of interest. Chi-square test was used for comparison between subgroups; multivariable regression analysis was used to adjust for confounders. Results: Of 108,195 hospitalizations for ICD placement, 4,015 (3.7%) had co-existing PEM. Post ICD placement, patients with co-existing PEM had higher inpatient mortality rate (5.4% vs 0.9%, p<0.0001), increased adjusted mean LOS and THC of 10 days (p<0.0001) and $161,252 (p<0.0001) respectively. Increased odds of circulatory post procedural complication (aOR 1.59, 95% CI 1.16–2.17, p=0.0004), ARF (aOR 1.73, 95% CI 1.48–2.03, p<0.001), and CVA (aOR 1.88, 95% CI 1.13–3.08, p=0.014) were noted in the PEM group. Conclusions: Patients admitted for ICD placement with concomitant PEM have increased in-hospital mortality, LOS, THC, and PPC. Careful attention to this comorbid malnutrition in patients that need ICD implantation is needed for early identification and treatment.