All-cause Hospitalization In Patients Research Articles

Abstract 12441: Ambient Fine Particulate Matter Air Pollution but Not Ozone is Associated With Elevated Risk of All-Cause Hospitalization in Patients With a Prior Diagnosis of Atrial Fibrillation

Introduction: Short-term increases (days to weeks) in fine particulate matter (PM 2.5 ) air pollution are associated with atrial fibrillation (AF) episodes. We previously reported that PM 2.5 was not associated with severe AF measured as emergency or inpatient hospitalization for the primary diagnosis of AF. Mild AF, though, may influence all-cause hospitalizations. This study evaluated if short-term increases in PM 2.5 and ozone were associated with all-cause hospitalization at 11 Intermountain Health hospitals in patients with AF, and if this differed between wildfire (June-Oct.) and winter inversion (Nov.-March) seasons. Methods: Patients carrying an AF diagnosis (N=347,157) were evaluated for all-cause hospitalization and, secondarily, AF hospitalization (N=25,601) and first AF diagnosis (N=77,893). PM 2.5 levels were measured from January 1, 1999 to March 31, 2022 (ozone: 2006-2022) in subjects residing on Utah’s Wasatch Front. Using the case-crossover design that matched individual-level characteristics, Poisson regression also adjusted for weather variables. Results: Mean age was 72±15 years and 51.0% were female. Overall, PM 2.5 increases at a lag of 0 days, 1 day, 3-day moving average (mAvg) (days 0-2), and 7-day mAvg (days 0-6) were associated with all-cause hospitalization [respectively: odds ratio (OR)=1.010, 1.008, 1.011, 1.009 per +10 μg/m 3 ; p=0.0004, 0.006, 0.0004, 0.028]. Associations differed by seasons (Figure). Regressions entering both ozone and PM 2.5 mildly increased PM 2.5 ORs for all-cause hospitalization. PM 2.5 was not associated with first AF diagnosis. Increases in ozone were not associated with higher risk of any outcome. Conclusions: Short-term increases in PM 2.5 air pollution were associated with all-cause hospitalization in patients with a prior AF diagnosis. Lag structure varied for wildfire and inversion seasons, with greater effect sizes in wildfire season. Increases in ozone did not associate with elevated risk.

Association of Prefrailty and Frailty With All-Cause Mortality, Acute Exacerbation, and Hospitalization in Patients With Chronic Obstructive Pulmonary Disease: A Meta-Analysis.

To evaluate the impact of prefrailty and frailty on all-cause mortality, acute exacerbation, and all-cause hospitalization in patients with chronic obstructive pulmonary disease (COPD). Meta-analysis. Two authors independently searched PubMed, Web of Science, and Embase databases until December 27, 2022，to identify studies that reported the predictive value of prefrailty and frailty in COPD patients. All-cause mortality, acute exacerbation, and all-cause hospitalization. Ten studies reporting on 11 articles enrolling 13,203 patients with COPD were included. The prevalence of frailty ranged from 6.0% to 51%. When compared with nonfrailty, the pooled adjusted hazard ratio (HR) of all-cause mortality was 1.48 (95% CI 0.92-2.40) for prefrailty and 2.64 (95% CI 1.74-4.02) for frailty, respectively. The pooled adjusted odds ratio (OR) of all-cause hospitalization was 1.35 (95% CI 1.05-1.74) for prefrailty and 1.65 (95% CI 1.05-2.61) for frailty. In addition, frailty significantly predicted all acute exacerbation (OR 2.20, 95% CI 1.26-3.81) but not moderate to severe acute exacerbation (OR 1.42, 95% CI 0.94-2.17) in patients with stable COPD. However, the pooled results of all-cause hospitalization were not reliable in leave-1-out sensitivity analyses. Frailty significantly predicts all-cause mortality in patients with COPD, even after adjustment for common confounding factors. Assessment of frail status in COPD patients may improve secondary prevention and allow early intervention. However, future studies are warranted to validate the impact of frailty defined by a standardized definition of frailty on acute exacerbation and all-cause hospitalization.

CO138 Comparative Effectiveness and Costs of Sacubitril/Valsartan Versus Angiotensin Receptor Blockers in Heart Failure with Preserved Ejection Fraction

Sacubitril/valsartan (SAC/VAL) and angiotensin receptor blockers (ARB) are recommended therapy for heart failure with preserved ejection fraction (HFpEF), but little is known about their real-world comparative effectiveness and costs. We aimed to assess comparative effectiveness of SAC/VAL vs. ARB for preventing HF-related and all-cause hospitalizations in patients with HFpEF and their related medical costs.

Self-rated health as a predictor of hospitalizations in patients with bipolar disorder or major depressive disorder: A prospective cohort study of the UK Biobank

BackgroundTo determine the association between self-rated health (SRH) and subsequent all-cause hospitalizations in patients with bipolar disorder (BD) or major depression (MDD). MethodsWe conducted a prospective cohort study on people with BD or MDD in the UK from 2006 to 2010 using UK Biobank touchscreen questionnaire data and linked administrative health databases. The association between SRH and 2-year all-cause hospitalizations was assessed using proportional hazard regression after adjustment for sociodemographics, lifestyle behaviors, previous hospitalization use, the Elixhauser comorbidity index, and environmental factors. ResultsA total of 29,966 participants were identified, experiencing 10,279 hospitalization events. Among the cohort, the average age was 55.88 (SD 8.01) years, 64.02 % were female, and 3029 (10.11 %), 15,972 (53.30 %), 8313 (27.74 %), and 2652 (8.85 %) reported excellent, good, fair, and poor SRH, respectively. Among patients reporting poor SRH, 54.19 % had a hospitalization event within 2 years compared with 22.65 % for those having excellent SRH. In the adjusted analysis, patients with good, fair, and poor SRH had 1.31 (95 % CI 1.21–1.42), 1.82 (95 % CI 1.68–1.98), and 2.45 (95 % CI 2.22, 2.70) higher hazards of hospitalization, respectively, than those with excellent SRH. LimitationsSelection bias can exist as our cohort cannot fully represent all the BD and MDD cases in the UK. Moreover, the causality is questionable. ConclusionSRH was independently associated with subsequent all-cause hospitalizations in patients with BD or MDD. This large study underscores the need for proactive SRH screening in this population, which might inform resource allocation in clinical care and enhance high-risk population detection.

Rehospitalization of Patients with Advanced Heart Failure Receiving Continuous, Palliative Dobutamine or Milrinone

This study aims to determine the incidence of all-cause hospitalization in patients with advanced heart failure (AHF) receiving ambulatory continuous, intravenous dobutamine versus milrinone for palliative intent. Despite medical optimization, patients with AHF develop refractory symptoms, resulting in frequent hospitalizations. Previous trials precede modern care standards. Data regarding inotrope choice in palliation are limited. This retrospective analysis included 222 patients with AHF and reduced left ventricular ejection fraction discharged on palliative dobutamine (n=135) or milrinone (n=87). The primary outcome was incidence of all-cause rehospitalization compared by treatment type. Demographics between groups were similar. In the milrinone arm, more patients were discharged on β blockers (62% vs 22%; p <0.001); fewer patients were discharged to hospice (6% vs 30%). More patients in the milrinone arm than in the dobutamine arm were rehospitalized within 180 days (80% vs 59%; p=0.002); when patients discharged to hospice were excluded, this difference was no longer significant (83% vs 74%; p=0.14). Overall mortality was lower in the milrinone arm (63% vs 80%; p=0.006); survival was longer (median: 228 vs 52 days; p <0.001). Patients receiving milrinone spent more days alive and out of the hospital at 90 days after discharge (70 vs 37 days; p <0.001). In conclusion, in patients with AHF receiving palliative inotropes, there was no difference in rehospitalization when excluding patients discharged to hospice. Milrinone use was associated with decreased mortality and longer survival. Agent selection must closely align with the patient's disease trajectory.

Pulmonary Artery Pressure Monitoring Effectively Guides Management to Reduce Heart Failure Hospitalizations in Obesity

ObjectivesThis study sought to determine the impact of therapy guided by pulmonary artery (PA) pressure monitoring in patients with heart failure (HF) and obesity. BackgroundObesity is prevalent in HF and associated with volume retention, but it complicates clinical assessment of congestion. MethodsThe CardioMEMS Post Approval Study was a prospective, multicenter, open-label trial in 1,200 patients with New York Heart Association functional class III HF and prior HF hospitalization (HFH) within 12 months. Patients with a body mass index (BMI) >35 kg/m2 were required to have a chest circumference <65 inches. Therapy was guided by PA pressure monitoring at sites, and HFHs were adjudicated 1 year before implantation and throughout follow-up. This analysis stratified patients according to ejection fraction (EF) <40% or ≥40% and by BMI <35 kg/m2 or ≥35 kg/m2. ResultsBaseline PA diastolic pressure was higher in patients with BMI ≥35 kg/m2 regardless of EF, but all PA pressures were reduced at 12 months in each cohort (P < 0.0001). HFH rate was reduced by >50% in both cohorts for EF <40% (BMI <35 kg/m2 [HR: 0.48; 95% CI: 0.41-0.55] and ≥35 kg/m2 [HR: 0.40; 95% CI: 0.31-0.53]) and EF ≥40% (BMI <35 kg/m2 [HR: 0.42; 95% CI: 0.35-0.52] and ≥35 kg/m2 [HR: 0.34; 95% CI: 0.25-0.45]; P < 0.0001). There was a nonsignificant trend toward greater reduction with more obesity. The all-cause hospitalization rate was also significantly reduced during monitoring (P < 0.01). ConclusionsManagement guided by PA pressure monitoring effectively reduced pressures, HFH, and all-cause hospitalization in patients with obesity regardless of EF. (CardioMEMS HF System Post Approval Study; NCT02279888)

Hospitalization Risk for Medicare Beneficiaries With Nontuberculous Mycobacterial Pulmonary Disease

BackgroundNontuberculous mycobacterial pulmonary disease (NTM-PD) is an uncommon mycobacterial infection characterized by worsening lung function and increased health care resource utilization; however, the overall risk for hospitalization among patients with NTM-PD remains unclear.Research QuestionWhat is the hospitalization risk among older adults with NTM-PD?Study Design and MethodsA retrospective, nested, case-control study was conducted by using the Medicare claims database. Cases were defined as patients with ≥ 2 NTM-PD claims ≥ 30 days apart between January 1, 2007, and December 31, 2015. The study included individuals aged ≥ 65 years with ≥ 12 months of continuous enrollment in both Parts A and B before the first NTM-PD diagnosis. Cases were matched 1:2 to Medicare beneficiaries without NTM-PD (control subjects) according to age and sex. Hospitalizations following the first NTM-PD claim were compared between case and control subjects by using univariate and multivariate analyses.ResultsA total of 35,444 case subjects and 65,467 matched control subjects (mean age, 76.6 years; 70% female; ≥ 87% White) were identified. Baseline comorbidities, particularly pulmonary comorbidities, were more common in case subjects than in control subjects (81.1% vs 17.7% for COPD; 44.6% vs 0.6% for bronchiectasis). All-cause hospitalization was observed in 65.7% of case subjects and 44.9% of control subjects. Unadjusted annual hospitalization rates were significantly (P < .05) greater among case subjects than control subjects. Case subjects also had a significantly shorter time to hospitalization than control subjects. The increased burden due to hospitalization was reflected in multivariate analysis adjusting for baseline comorbidities. All-cause hospitalization in patients with NTM-PD relative to control subjects was 1.2 times more likely (relative risk, 1.23; 95% CI, 1.21-1.25; P < .0001) with a 46% greater hazard (hazard ratio, 1.46; 95% CI, 1.43-1.50; P < .0001).InterpretationPatients with NTM-PD were significantly more likely to be hospitalized, had greater annualized hospitalization rates, and had shorter time to hospitalization than age- and sex-matched control subjects without NTM-PD. These findings highlight the significantly increased burden of hospitalizations among patients with NTM-PD.

790-P: Empagliflozin Reduced the Total Burden of Events Leading to or Prolonging Hospitalization in EMPA-REG OUTCOME

Background: In EMPA-REG OUTCOME, empagliflozin (EMPA) reduced the risk of all-cause mortality (ACM) and total (first plus recurrent) events leading to all-cause hospitalization in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD). We assessed the effect of EMPA on the total burden of events leading to or prolonging all-cause hospitalization (ACPH) as well as the composite of ACPH and ACM.Methods: Patients were randomized to EMPA 10 mg, 25 mg, or placebo. Post hoc, we assessed the effect of pooled EMPA vs. placebo on total events of ACPH, as reported by investigators, and an ACPH/ACM composite, using a negative binomial model.Results: Among 7,020 patients, there were 5,256 ACPH events (5,031 leading to and 225 prolonging hospitalization) and 5,617 ACPH/ACM events. EMPA reduced the risk of total events of ACPH by 22% vs. placebo (rate ratio [95% CI]: 0.78 [0.70, 0.87]) and ACPH/ACM by 24% vs. placebo (0.76 [0.69, 0.85]) (Figure). The number of ACPH/ACM events prevented with EMPA vs. placebo was 67.7 per 1000 patient years; the number needed to treat (NNT) (95% CI) over the three years of the trial to prevent one event was 4.9 (3.5, 8.4).Conclusions: EMPA showed a sizeable reduction in the total burden of mortality and events leading to or prolonging hospitalization in patients with T2D and ASCVD, with a clinically relevant number of events prevented and a low NNT.View largeDownload slideView largeDownload slide DisclosureS. E. Inzucchi: Consultant; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Esperion, Merck & Co., Inc., Novo Nordisk. C. Wanner: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, Speaker’s Bureau; Self; Eli Lilly and Company. D. H. Fitchett: None. B. Zinman: Advisory Panel; Self; Abbott Diabetes, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk, Sanofi. S. Anker: Consultant; Self; Abbott, Bayer AG, Boehringer Ingelheim International GmbH, Cardiac Dimensions Pty. Ltd., Impulse Dynamics, Novartis AG, Servier Laboratories, Vifor Pharma Management Ltd., Other Relationship; Self; Abbott, Vifor Pharma Management Ltd. M. Mattheus: Employee; Self; Boehringer Ingelheim Pharma GmbH & Co. KG. O. Vedin: Employee; Self; Boehringer Ingelheim International GmbH. S. Hantel: Employee; Self; Boehringer Ingelheim Pharma GmbH & Co. KG. S. S. Lund: Employee; Self; Boehringer Ingelheim International GmbH, Other Relationship; Self; No specific name - possibly multiple companies, Stock/Shareholder; Self; Novo Nordisk A/S.

MO816PULSE PRESSURE IS AN INDEPENDENT PREDICTOR OF THE RISK OF RECURRENT ALL-CAUSE HOSPITALIZATION IN CHRONIC HEMODIALYSIS PATIENTS

Abstract Background and Aims Pre - and peri-dialytic systolic blood pressures (SBP) have been linked to heightened cardiovascular morbidity and mortality in hemodialysis (HD) patients. High pulse pressure (PP) is clinically associated with increased arterial stiffness and atrial fibrillation, while low PP is associated with cardiac insufficiency. We studied the relationship between PP and all-cause hospitalization in patients undergoing maintenance HD. Method This retrospective cohort study was performed in HD patients from January 2015 to May 2020. To be included in the study, patients were required to be 18 or older, dialysis vintage of at least a year, and must have received treatment within the first 30 days after dialysis initiation. We developed Cox proportional hazards models with spline corrected terms for recurrent all-cause hospitalizations. 95% confidence interval (CI) were also computed. Further, we stratified the patient population into 4 SBP categories, namely: SBP &amp;lt; 120, 120 ≤ SBP &amp;lt; 150, 150 ≤ SBP &amp;lt; 180, and SBP ≥ 180 mmHg, and investigated the mediating effects of SBP on hospitalization risk. Results We studied 2453 HD patients (age 58.9±16.1 years, 58% male) dialyzed between January 2014 and October 2018 in Renal Research Institute facilities. We observe that PPs between 45 and 70 mmHg were associated with lower risk of recurrent hospitalization (Figure 1a), possibly driven by the behavior of SBPs between 120 to 180 mmHg (Figure 1c-e). No statistically significant association was seen between PP and hospitalization for patients with SPB &amp;lt;120mmHg and &amp;gt;180mm (Figures 1b-d). A decreasing trend with PP greater than 90mmHg is noted but rendered negligible, and a statistical artifact caused by a case mix at these unusually high levels. The lack of significant associations between inflammatory (NLR) and nutritional (Albumin and phosphorus) factors renders PP a significant and independent predictor of recurrent hospitalization adding to the current knowledge in the field. Conclusion Our analysis found associations between PP (with and without SBP stratification) and the risk of recurrent hospitalization and all-cause mortality. Even after adjustment for hospitalization risk and other clinical, inflammatory, and nutritional parameters at baseline PP remained an independent predictor of recurrent hospitalizations. Further investigations into the relationship are needed to better understand the mediating effects of PP as a driver of hospitalization and mortality risk.

Canagliflozin Reduces All-cause Hospitalization in Patients with Type 2 Diabetes Mellitus

Background: Canagliflozin has been shown to improve cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease. Objective: We investigated the impact of canagliflozin on all-cause hospitalizations (ACH). Methods: Participant-level data was analyzed from the CANVAS Program and CREDENCE trials. Proportional means model was used to compare the mean cumulative function of ACH events over time between canagliflozin and placebo overall (adjusted for baseline estimated glomerular filtration rate [eGFR] strata) and within each stratum of baseline eGFR (<45, 45-60, and >60mL/min/1.73m2). Results: In 14,540 participants during a mean follow-up of 3.3 years, 5031 (34.6%) participants were hospitalized and a total 10,136 ACH were reported. Overall, 1919 (13.2%), 2972 (20.4%), and 9649 (66.4%) participants had eGFR <45, 45-60, and >60mL/min/1.73m2, respectively. When adjusted for eGFR, canagliflozin, compared with placebo, significantly reduced ACH (205.3 versus 235.1 events per 1000 patient-years, respectively; mean number of events ratio [MER] 0.91, 95% confidence interval [CI] 0.87-0.95). Canagliflozin significantly reduced ACH in participants with eGFR <45mL/min/1.73m2 (311.8 versus 407.3 events per 1000 patient-years; MER 0.79, 95% CI 0.71-0.87) and 45-60mL/min/1.73m2 (250.5 versus 297.9 events per 1000 patient- years; MER 0.85, 95% CI 0.78-0.92), but not >60mL/min/1.73m2 (181.9 versus 188.0 events per 1000 patient-years; MER 0.97, 95% CI 0.93-1.03; interaction p <0.0001). Conclusion: ACH was common with over one-third of participants hospitalized during a mean follow-up of 3.3 years. In these analyses, canagliflozin reduced ACH in patients with type 2 diabetes mellitus, with greater absolute and relative effects in those with lower eGFR.

69-OR: Freestyle Libre System Use Is Associated with Reduction in Inpatient and Outpatient Emergency Acute Diabetes Events and All-Cause Hospitalizations in Patients with Type 2 Diabetes

Continuous glucose monitors (CGMs) improve glycemic control compared with self-monitoring of blood glucose. We aim to describe clinical outcomes in people with type 2 diabetes (T2D) who received FreeStyle Libre® system. IBM MarketScan™ Commercial Claims and Medicare Supplemental databases were used in this retrospective, observational analysis. MarketScan contains insurance billing claims for inpatient, outpatient, and pharmacy expenses. Cohort requirements included: de novo FreeStyle Libre system purchase in 2017 Q4-2018 Q2, diagnosis of T2D, ≥18 years old, fast- or short-acting insulin, and ≥6-months pre-CGM observation time. Primary outcome was acute diabetes events (ADE): hospitalization with hyper-/hypoglycemia as the primary diagnosis or outpatient emergency associated with a code of hyper-/hypoglycemia. Secondary outcome was all-cause hospitalizations. Andersen-Gill Cox regression compared event rates 6-months pre-/post-CGM. The cohort (n=1,244, age 53.6±9.7 years, 53.8% male) experienced a reduction in ADE from 0.158 to 0.077 events/patient-year (HR: 0.49 [0.34 0.69]; P:&amp;lt;0.001). Hospitalizations also reduced from 0.345 to 0.247 events/patient-year (HR: 0.72 [0.58 0.88]; P:0.002). After FreeStyle Libre system purchase, T2D patients had lower rates of ADE and all-cause hospitalizations. Disclosure R.M. Bergenstal: Consultant; Self; Ascensia Diabetes Care, Johnson &amp; Johnson. Other Relationship; Self; Abbott, Dexcom, Inc., Hygieia, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Onduo, Roche Diabetes Care, Sanofi, UnitedHealth Group. M.S.D. Kerr: Employee; Self; Abbott. G.J. Roberts: Employee; Self; Abbott. D. Souto: Employee; Self; Abbott. Y. Nabutovsky: Employee; Self; Abbott. I.B. Hirsch: Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care. Research Support; Self; Medtronic, Omnipod.

85-LB: Freestyle Libre System Use Associated with Reduction in Acute Diabetes Events and All-Cause Hospitalizations in Patients with Type 2 Diabetes without Bolus Insulin

Data on the benefit of continuous glucose monitors (CGM) in people with diabetes not using intensive insulin therapy is limited. We describe clinical outcomes after a FreeStyle Libre® system purchase in people with type 2 diabetes (T2D) not using bolus insulin. IBM MarketScan™ Commercial Claims and Medicare Supplemental databases were used in this retrospective, observational analysis. MarketScan contains insurance billing claims for inpatient, outpatient, and pharmacy. Cohort requirements included: de novo CGM, FreeStyle Libre system purchase 2017 Q4-2018 Q4, T2D diagnosis, ≥18 years old, no fast-/short-acting insulin, ≥6-months pre-index observation time. Primary outcome was acute diabetes events (ADE): hospitalization with hyper-/hypoglycemia as primary diagnosis or outpatient emergency with same codes. Secondary outcome was all-cause hospitalization. Andersen-Gill Cox regression compared event rates 6-months pre-/post-index. The cohort (n= 7,167, age 53.3±9.5 years, 51.5% male, avg. post-index follow-up 155 days) saw a reduction in ADE from 0.071 to 0.052 events/pt-yr (HR: 0.70 [0.57 0.85]; P:&amp;lt;0.001). Hospitalizations reduced from 0.180 to 0.161 events/pt-yr (HR: 0.87 [0.78 0.98]; P: 0.025). After FreeStyle Libre system purchase, T2D patients not on bolus insulin had lower rates of ADE and all-cause hospitalization. Disclosure E. Miller: None. M.S.D. Kerr: Employee; Self; Abbott. G.J. Roberts: Employee; Self; Abbott. D. Souto: Employee; Self; Abbott. Y. Nabutovsky: Employee; Self; Abbott. E. Wright: Advisory Panel; Self; Abbott, Sanofi. Consultant; Self; Abbott, AstraZeneca, Bayer U.S., Boehringer Ingelheim Pharmaceuticals, Inc., MannKind Corporation, Merck &amp; Co., Inc., Voluntis France. Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes.

Comparison of the Effect of Catheter Ablation for Atrial Fibrillation on All-Cause Hospitalization in Patients With Versus Without Heart Failure (from the Nationwide Readmission Database)

Catheter ablation (CA) is associated with reduced arrhythmia recurrence and improved quality of life in patients with atrial fibrillation (AF). Heart failure (HF) is common in patients with AF and is associated with a high hospitalization burden. The real-world association between CA and rates of subsequent hospitalization in patients with AF and HF has not been well studied. Patients who underwent CA for AF during the middle 4 months of each year 2010 to 2015 were identified using the Nationwide Readmission Database. Patients were grouped according to the HF status and HF patients were stratified to reduced versus preserved ejection fraction (EF) using ICD-9 codes. Rates of all-cause hospitalization 120 days before and after index admission were compared using the McNemar's test, before and after matching for baseline characteristics. A total of 10,966 patients met inclusion criteria, including 1,950 with HF. In the HF group, all-cause hospitalization rates changed from 45.8% before CA to 33.2% after (p <0.001). Corresponding rates for non-HF patients were 23.8% and 19.7% (p< 0.001) with a greater relative reduction in hospitalizations seen in the HF group (27.5% vs 17.2%; p value <0.001). The difference in relative reduction persisted after adjustment by propensity score matching. The relative reduction in hospitalization rates was similar in HF patients with reduced and preserved EF with 25.2% and 28.5%, respectively. In conclusion, CA for AF was followed by a significant reduction in all-cause hospitalization rates. Patients with HF, regardless of EF, showed a greater reduction in admissions.

Effect of Influenza on Outcomes in Patients With Heart Failure

ObjectivesThis study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF). BackgroundPatients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF. MethodsWe queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs. ResultsOf 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40). ConclusionsInfluenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.

THE EFFECT OF TREPROSTINIL DOSE ON TIME TO ALL CAUSE AND PULMONARY ARTERIAL HYPERTENSION-RELATED HOSPITALIZATIONS

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Treprostinil (TRE) is a prostacyclin vasodilator indicated for treatment of pulmonary arterial hypertension (PAH). Oral and parenteral TRE are titrated based on tolerability and clinical response, with no established maximum dose. Due to disease progression and dose individualization, dose-response studies are difficult to conduct. Recent PAH clinical trials employed a composite endpoint of clinical worsening, with results largely driven by hospitalization and disease progression. The purpose of this analysis is to evaluate the effect of TRE dose on time to first PAH-related and all-cause hospitalization in patients with PAH. METHODS: The manufacturer’s global drug safety database was retrospectively analyzed for hospitalizations (Hs) that occurred after initiation of oral or subcutaneous (SC) TRE in the randomized, pivotal or open-label extension (OLE) studies. Hs were adjudicated for relatedness to PAH by a team of pharmacovigilance physicians employed by the manufacturer. Hs were considered not related to PAH if the patient was treated for another underlying etiology or experienced a decompensation due to an acute medical problem. Patients with available dosing data at last OLE study visit were included and grouped into unbiased tertiles based on this dose. Oral TRE doses were converted to ng/kg/min equivalents. Pairwise comparisons were made between dose groups to evaluate differences in time to first PAH-related and all-cause H. RESULTS: 759 oral TRE and 860 SC TRE patients were included in this long-term analysis. 381 (50.2%) oral TRE patients were hospitalized, including 236 (31.1%) due to PAH. Oral TRE dose groups were <15.7, 15.7-37.4, and >37.4 ng/kg/min (Groups 1/2/3). Median time to PAH-related and all-cause H was 339/412/658 days and 293/400/552 days for Groups 1/2/3, respectively. There was a significant difference between Groups 1 and 3 for both PAH-related and all-cause H (p<0.001, both) and between Groups 1 and 2 for all-cause H (p=0.003). 349 (40.6%) SC TRE were hospitalized, including 160 (18.6%) due to PAH. SC TRE dose groups were <8.3, 8.3-30, and >30 ng/kg/min (Groups 1/2/3). Median time to PAH-related and all-cause H was 83/318/428 days and 95/266/310 days in Groups 1/2/3, respectively. There were significant differences between Groups 1 and 2 and Groups 1 and 3 for both PAH-related and all-cause H (p<0.001, all). CONCLUSIONS: Patients receiving higher oral and SC TRE doses have a significantly longer time to first PAH-related and all-cause H, as compared to those receiving lower doses. CLINICAL IMPLICATIONS: Results suggest the importance of aggressive oral and SC TRE dose up titration in patients with PAH. DISCLOSURES: Employee relationship with United Therapeutics Please note: >$100000 Added 02/09/2018 by Erick Borg, source=Web Response, value=Salary Employee relationship with United Therapeutics Please note: >$100000 Added 03/02/2018 by Meredith Broderick, source=Web Response, value=Salary Employee relationship with United Therapeutics Please note: >$100000 Added 03/02/2018 by Andrew Nelsen, source=Web Response, value=Salary No relevant relationships by Gautam Ramani, source=Web Response Employee relationship with United Therapeutics Please note: >$100000 Added 03/02/2018 by Amanda Saunders, source=Web Response, value=Salary My spouse/partner as a Employee relationship with GlaxoSmithKline Please note: >$100000 Added 03/02/2018 by Amanda Saunders, source=Web Response, value=Salary

P975Incidence and risk factors for all-cause hospitalizations in patients with atrial fibrillation: a systematic review and meta-analysis

P975Incidence and risk factors for all-cause hospitalizations in patients with atrial fibrillation: a systematic review and meta-analysis

Abstract 16714: Real-World Cost of All-Cause Hospitalizations Over a 12-Month Period After Acute Venous Thromboembolism

Recent clinical trial data have shown that newer oral anticoagulants may reduce all-cause hospitalizations in patients with venous thromboembolism (VTE) who complete anticoagulation therapy for 6-12 months. To understand the potential cost implications of such hospitalization reductions, this study sought to quantify the real-world cost of all-cause hospitalizations over a 12-month period after acute VTE. This was a retrospective cohort study using U.S. health insurance claims data. Patients included in the study were aged ≥18 years, had experienced a non-fatal hospitalization or ED visit with a principal diagnosis of VTE between 1-Jan-2007 and 31-Mar-2013 (first visit=index) and had ≥1 claim for anticoagulation (warfarin, enoxaparin, rivaroxaban) or placement of an inferior vena cava filter ≤30 days after index. For up-to one year after discharge from the hospitalization or ED visit for acute VTE, patients were followed to identify the occurrence and costs of all-cause hospitalizations. Multivariable regressions were used to compare per-patient per-month (PPPM) total healthcare costs between patients with vs. without a hospitalization during follow-up. The final cohort included 123,665 patients (mean age 59 years, 50% male). During an overall mean follow-up of 284 days after discharge from the acute VTE event, 33,843 patients were hospitalized at least once for any cause within 1 year and 37% of these hospitalized patients had at least one hospitalization for VTE. Among patients who were hospitalized, mean (standard deviation) PPPM hospital length of stay and PPPM costs for hospitalizations were 1.4 (2.8) and $5,800 ($14,723) at 1 year. Adjusted incremental PPPM differences in total healthcare costs between patients with vs. without a hospitalization during the 1-year follow-up were $ $4,808 (P&lt;0.001). Conclusion: Hospitalizations within 1 year after acute VTE are common and costly. VTE treatments which reduce hospitalizations after acute VTE may confer substantial cost offsets.

Prognostic Significance of Hyponatremia Among Ambulatory Patients With Heart Failure and Preserved and Reduced Ejection Fractions

Hyponatremia in heart failure (HF) is an established predictor of adverse outcomes in hospitalized patients with reduced ejection fraction (EF). However, there is a paucity of data in ambulatory patients with HF with preserved ejection fraction (HFpEF). We examined the prevalence, risk factors, and long-term outcomes of hyponatremia (serum sodium ≤135 mEq/L) in ambulatory HFpEF and HF with reduced EF (HFrEF) in a national cohort of 8,862 veterans treated in Veterans Affairs clinics. Multivariable logistic regression models were used to identify factors associated with hyponatremia, and multivariable Cox proportional hazard models were used for analysis of outcomes. The cohort consisted of 6,185 patients with HFrEF and 2,704 patients with HFpEF with a 2-year follow-up. Hyponatremia was present in 13.8% and 12.9% patients in HFrEF and HFpEF, respectively. Hyponatremia was independently associated with younger age, diabetes, lower systolic blood pressure, anemia, body mass index <30 kg/m(2), and spironolactone use, whereas African-American race and statins were inversely associated. In multivariate analysis, hyponatremia remained a significant predictor of all-cause mortality in both HFrEF (hazards ratio [HR] 1.26, 95% confidence interval [CI] 1.11 to 1.44, p <0.001) and HFpEF (HR 1.40, 95% CI 1.12 to 1.75, p = 0.004) and a significant predictor of all-cause hospitalization in patients with HFrEF (HR 1.18, 95% CI 1.07 to 1.31, p = 0.001) but not in HFpEF (HR 1.08, 95% CI 0.92 to 1.27, p = 0.33). In conclusion, hyponatremia is prevalent at a similar frequency of over 10% in ambulatory patients with HFpEF and HFrEF. Hyponatremia is an independent prognostic marker of mortality across the spectrum of patients with HFpEF and HFrEF. In contrast, it is an independent predictor for hospitalization in patients with HFrEF but not in patients with HFpEF.

Effect of the arteriovenous access for hemodialysis on subendocardial viability ratio, pulse pressure and hospitalizations

In some patients the potential benefits of the arteriovenous (AV) access over catheter for hemodialysis seem to be outweighed by global cardiovascular status deterioration. We prospectively evaluated 44 pre-dialysis chronic kidney disease patients submitted to vascular access creation during a follow-up of 25 ± 9 months. We performed pulse wave analysis and biochemical assessment before and 2 months after AV access construction, and we registered premature vascular access thrombosis, and all-cause and cardiovascular hospitalizations throughout follow-up. We found a statistically significant decrease in the subendocardial viability ratio (SEVR) and pulse pressure (PP) parameters after AV access creation while brain natriuretic peptide significantly increased. Receiver operating characteristic curve analysis identified SEVR ≤113 % evaluated 2 months after vascular access construction as the best cutoff value for predicting all-cause and cardiovascular hospitalizations. Kaplan-Meier analysis showed that a SEVR ≤113 % was associated with all-cause (p = 0.010) and cardiovascular (p = 0.029) hospitalizations; Cox regression analysis verified a 4.9-fold higher risk of all-cause hospitalization in patients with SEVR ≤113 % (p = 0.005). To our best knowledge, this report indicates, for the first time, that despite the decrease in PP parameters, the creation of a vascular access for hemodialysis was also associated with a reduction of SEVR which predicted a worse clinical outcome. We argue that the decrease of pulse pressure after arteriovenous construction may reflect a new hemodynamic set-point after vascular access creation and may not indicate a protective cardiovascular effect.

Human heart failure is accompanied by altered protein kinase A subunit expression and post-translational state

β-Adrenergic receptor blockade reduces total mortality and all-cause hospitalizations in patients with heart failure (HF). Nonetheless, β-blockade does not halt disease progression, suggesting that cAMP-dependent protein kinase (PKA) signaling downstream of β-adrenergic receptor activation may persist through unique post-translational states. In this study, human myocardial tissue was used to examine the state of PKA subunits. As expected, total myosin binding protein-C phosphorylation and Ser23/24 troponin I phosphorylation significantly decreased in HF. Examination of PKA subunits demonstrated no change in type II regulatory (RIIα) or catalytic (Cα) subunit expression, although site specific RIIα (Ser96) and Cα (Thr197) phosphorylation were increased in HF. Further, the expression of type I regulatory subunit (RI) was increased in HF. Isoelectric focusing of RIα demonstrated up to three variants, consistent with reports that Ser77 and Ser83 are in vivo phosphorylation sites. Western blots with site-specific monoclonal antibodies showed increased Ser83 phosphorylation in HF. 8-fluo-cAMP binding by wild type and phosphomimic Ser77 and Ser83 mutant RIα proteins demonstrated reduced Kd for the double mutant as compared to WT RIα. Therefore, failing myocardium displays altered expression and post-translational modification of PKA subunits that may impact downstream signaling.