THE IMPACT OF CARDIAC ARRHYTHMIAS ON INFLAMMATORY BOWEL DISEASE (IBD)

Abstract

Abstract BACKGROUND Chronic inflammation in patients with IBD is theorized to be a trigger for cardiac arrhythmias in this patient population. There is a paucity of studies that study the risk factors and outcomes associated with cardiac arrhythmias in patients with IBD. Our study aims to investigate hospital mortality, hospital length of stay (LOS), and total charges between both patient groups. METHODS Data was extracted from the National Inpatient Sample (NIS) 2016-2019 Database using ICD -10 codes. The NIS was searched for hospitalizations involving adult patients with ulcerative colitis (UC) and Crohn’s disease (CD), as a principal discharge diagnosis. Cardiac arrhythmias, including atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, cardiac arrest, and supraventricular tachycardias (SVT) was used as a secondary diagnosis. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. RESULTS Among 1,165,075 patients who had IBD, 133,270 (11.4%) had cardiac arrhythmias. The adjusted odds ratio (OR) for inpatient mortality (OR 3.44, p<0.0001), hospital length of stay (LOS) (+1.78 days, p<0.0001), and total hospital charges (+25,727, p<0.0001) for IBD and cardiac arrhythmias compared to those patients with only IBD were all statistically significant. Independent positive predictors of increased mortality were the following: fistula formation (OR 3.02), hematochezia (OR 2.63), hypovolemia (OR 1.61), electrolyte abnormalities (OR 1.46), bowel resection (OR 1.37). Interestingly, patients undergoing colonoscopy (OR 0.48, p<0.0001) had less mortality. Independent positive predictors of increased LOS and total hospital charges were the following: fistula formation (+4.9 days, +$52,890 p<0.0001 for both), bowel obstruction (+1.3 days, +$10,000 p<0.0001 for both), hematochezia (+1.0 days, +13,736, p<0.0001 for both), electrolyte abnormalities (+1.9 days, +$15,999, p<0.0001, for both), colonoscopy (+1.9 days, +14,577, p<0.0001 for both), bowel resection (+4.5 days, +75,444, p<0.0001 for both). CONCLUSION Our population-based study provides evidence that there is a significant increase in mortality, hospital LOS, and total charges for the subpopulation of IBD patients with cardiac arrhythmias. It is important to note that many patients in the IBD population have concomitant cardiac arrhythmias (>10% in this study) which leads to an increased burden on the healthcare system. It is important for practitioners to recognize the risk factors associated with worsening outcomes in this patient subpopulation as early intervention can help mitigate negative outcomes. The management of IBD is complex and this study illustrates the importance of a multidisciplinary team to help maximize patient care.