Higher Odds Of In-hospital Mortality Research Articles

Care fragmentation and readmission mortality and length of stay before and during the COVID-19 pandemic: data from the National Readmissions Database, 2018–2020

ImportanceA quarter of all 30-day readmissions involve fragmented care, where patients return to a different hospital than their original admission; these readmissions are associated with increased in-hospital mortality and longer lengths-of-stay (LOS). The stress on healthcare systems at the beginning of the COVID-19 pandemic could worsen care fragmentation and related outcomes.ObjectiveTo compare fragmented readmissions in 2020 versus 2018–2019 and assess whether mortality and LOS in fragmented readmissions differed in the two time periods.DesignObservational studySettingNational Readmissions Database (NRD), 2018–2020ParticipantsAll adults (> 18 y/o) with 30-day readmissionsMain outcomes and measuresWe examined the percentage of fragmented readmissions over 2018–2020. Using unadjusted and adjusted logistic and linear regressions, we estimated the associations between fragmented readmissions and in-hospital mortality and LOS.Results24.0–25.7% of readmissions in 2018–2020 and 27.3%-31.0% of readmissions for COVID-19 were fragmented. 2018–2019 fragmented readmissions were associated with 18–20% higher odds of in-hospital mortality compared to nonfragmented readmissions. Fragmented readmissions for COVID-19 were associated with an 18% increase in in-hospital mortality (AOR 1.18, 95% CI 1.12, 1.24). The LOS of fragmented readmissions in March-November 2018–2019 were on average 0.81 days longer, while fragmented readmissions between March-November of 2020 were associated with a 0.88–1.03 day longer LOS.Conclusions and relevanceA key limitation is that the NRD does not contain information on several patient/hospital-level factors that may be associated with the outcomes of interest. We observed increased fragmentation during COVID-19, but its impact on in-hospital mortality and LOS remained consistent with previous years.

Frailty and In-Hospital Outcomes for Management of Cardiogenic Shock without Acute Myocardial Infarction.

(1) Background: Cardiogenic shock (CS) is associated with high morbidity and mortality. Frailty and cardiovascular diseases are intertwined, commonly sharing risk factors and exhibiting bidirectional relationships. The relationship of frailty and non-acute myocardial infarction with cardiogenic shock (non-AMI-CS) is poorly described. (2) Methods: We retrospectively analyzed the National Inpatient Sample from 2016 to 2020 and identified all hospitalizations for non-AMI-CS. We classified them into frail and non-frail groups according to the hospital frailty risk score cut-off of 5 and compared in-hospital outcomes. (3) Results: A total of 503,780 hospitalizations for non-AMI-CS were identified. Most hospitalizations involved frail adults (80.0%). Those with frailty had higher odds of in-hospital mortality (adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 2.03-2.20, p < 0.001), do-not-resuscitate status, and discharge to a skilled nursing facility compared with those without frailty. They also had higher odds of in-hospital adverse events, such as acute kidney injury, delirium, and longer length of stay. Importantly, non-AMI-CS hospitalizations in the frail group had lower use of mechanical circulatory support but not rates of cardiac transplantation. (4) Conclusions: Frailty is highly prevalent among non-AMI-CS hospitalizations. Those accompanied by frailty are often associated with increased rates of morbidity and mortality compared to those without frailty.

Systemic sclerosis is associated with increased in-patient mortality in patients hospitalized for heart failure.

We aimed to analyse the characteristics and in-hospital outcomes of patients hospitalized for heart failure (HF) with co-morbid systemic sclerosis (SSc) and compare them to those without SSc, using data from the National Inpatient Sample from years 2016 to 2019. International Classification of Diseases, Tenth Revision diagnosis codes were used to identify hospitalized patients with a primary diagnosis of HF and secondary diagnoses of SSc from the National Inpatient Sample database from 2016 to 2019. Patients were divided into two groups: those with and without a secondary diagnosis of SSc. Baseline characteristics including demographics and co-morbidities, outcomes of mortality, length of stay (LOS), and costs were compared between the two groups. Multivariable logistic regression analysis was performed to adjust for confounders and assess the impact of SSc on in-hospital mortality, cost, and LOS. A total of 4709724 hospitalizations for HF were identified, with 8150 (0.17%) having a secondary diagnosis of SSc. These patients were predominantly female (82.3% vs. 47.8%; P=0.01), younger (mean age of 67.4 vs. 71.4; P<0.01), and had significantly lower rates of traditional cardiovascular risk factors such as coronary artery disease (35.8% vs. 50.6%; P<0.01), hyperlipidaemia (39.1% vs. 52.9%; P<0.01), diabetes (22.5% vs. 49.1%; P<0.01), obesity (13.2% vs. 25.0%; P<0.01), and hypertension (20.2% vs. 23.8%; P<0.01). Higher rates of co-morbid pulmonary disease in the form of interstitial lung disease (23.1% vs. 2.0%; P<0.01) and pulmonary hypertension (36.6% vs. 12.7%; P<0.01) were noted in the SSc cohort. Unadjusted in-hospital mortality was significantly higher in the HF with SSc group [5.1% vs. 2.6%; odds ratio: 1.99; 95% confidence interval (CI): 1.60-2.48; P<0.001]. Unadjusted mortality was also higher among female (86.7% vs. 47.0%; P<0.01), Black (15.7% vs. 13.0%; P<0.01), and Hispanic (13.3% vs. 6.9%; P<0.01) patients in the SSc cohort. After adjusting for potential confounders, SSc remained independently associated with higher in-hospital mortality (adjusted odds ratio: 1.81; 95% CI: 1.44-2.28; P<0.001). Patients with HF and SSc also had longer LOS (6.4 vs. 5.4; adjusted mean difference [AMD]: 0.37, 95% CI: 0.05-0.68; P=0.02) and higher hospitalization costs ($67363 vs. $57128; AMD: 198.9; 95% CI: -4780 to 5178; P=0.93). In patients hospitalized for HF, those with SSc were noted to have higher odds of in-hospital mortality than those without SSc. Patients with HF and SSc were more likely to be younger, female, and have higher rates of co-morbid interstitial lung disease and pulmonary hypertension at baseline with fewer traditional cardiovascular risk factors.

Abstract TP230: Atrial Fibrillation and Short-Term Outcomes After Cancer-Related Ischemic Stroke

Introduction: Atrial fibrillation (AF) and cancer are both independently associated with worse outcomes in patients with acute ischemic stroke. Few studies have evaluated the impact of AF on outcomes of cancer-related stroke. We aimed to determine if AF is associated with worse short-term outcomes in patients with stroke and comorbid cancer. Methods: Using the 2016-2019 National Inpatient Sample, we identified all hospitalizations with diagnosis codes for cancer and ischemic stroke. The primary exposure was a diagnosis of AF. The primary outcome was in-hospital mortality. The secondary outcomes were length-of-stay and discharge other than to home. We used multivariable logistic and linear regression models, as appropriate, adjusted for age, gender, race-ethnicity, and the Charlson Comorbidity Index, to examine the association between AF and study outcomes. Results: Among 150,200 hospitalizations with diagnoses of cancer and ischemic stroke (mean age 72 years, 53% male), 40,084 (26.7%) included comorbid AF. Compared to hospitalizations without AF, hospitalizations with AF had higher rates of in-hospital mortality (14.8% vs 12.1%, p&lt;0.001) and non-home discharge disposition (83.5% vs 75.1%, p&lt;0.001) as well as longer mean length-of-stay (8.4 days vs 8.2 days, p&lt;0.001). In multivariable analyses, AF remained independently associated with higher odds of in-hospital mortality (adjusted OR, 1.34; 95% CI, 1.24-1.46), non-home discharge disposition (adjusted OR, 1.32; 95% CI, 1.23-1.42), and longer length-of-stay (adjusted mean difference, 13.7%; 95% CI, 10.9%-16.7%). Conclusions: In cancer-related ischemic stroke, comorbid AF is associated with worse short-term outcomes, including higher odds for in-hospital mortality, worse discharge disposition, and longer hospital stays.

African Americans Possessed High Prevalence of Comorbidities and Frequent Abdominal Symptoms, and Comprised A Disproportionate Share of Covid-19 Mortality among 9,873 Us- Hospitalized Patients Early in the Pandemic.

Identifying clinical characteristics and outcomes of different ethnicities in the US may inform treatment for hospitalized COVID-19 patients. Aim of this study is to identify predictors of mortality among US races/ethnicities. We retrospectively analyzed de-identified data from 9,873 COVID-19 patients who were hospitalized at 15 US hospital centers in 11 states (March 2020-November 2020). Main Outcomes and Measures: The primary outcome was to identify predictors of mortality in hospitalized COVID-19 patients. Among the 9,873 patients, there were 64.1% African Americans (AA), 19.8% Caucasians, 10.4% Hispanics, and 5.7% Asians, with 50.7% female. Males showed higher in-hospital mortality (20.9% vs. 15.3%, p=0.001). Non- survivors were significantly older (67 vs. 61 years) than survivors. Patients in New York had the highest in-hospital mortality (OR=3.54 (3.03 - 4.14)). AA patients possessed higher prevalence of comorbidities, had longer hospital stay, higher ICU admission rates, increased requirement for mechanical ventilation and higher in-hospital mortality compared to other races/ethnicities. Gastrointestinal symptoms (GI), particularly diarrhea, were more common among minority patients. Among GI symptoms and laboratory findings, abdominal pain (5.3%, p=0.03), elevated AST (n=2653, 50.2%, p=<0.001, OR=2.18), bilirubin (n=577, 12.9%, p=0.01) and low albumin levels (n=361, 19.1%, p=0.03) were associated with mortality. Multivariate analysis (adjusted for age, sex, race, geographic location) indicates that patients with asthma, COPD, cardiac disease, hypertension, diabetes mellitus, immunocompromised status, shortness of breath and cough possess higher odds of in-hospital mortality. Among laboratory parameters, patients with lymphocytopenia (OR2=2.50), lymphocytosis (OR2=1.41), and elevations of serum CRP (OR2=4.19), CPK (OR2=1.43), LDH (OR2=2.10), troponin (OR2=2.91), ferritin (OR2=1.88), AST (OR2=2.18), D-dimer (OR2=2.75) are more prone to death. Patients on glucocorticoids (OR2=1.49) and mechanical ventilation (OR2=9.78) have higher in-hospital mortality. These findings suggest that older age, male sex, AA race, and hospitalization in New York were associated with higher in-hospital mortality rates from COVID-19 in early pandemic stages. Other predictors of mortality included the presence of comorbidities, shortness of breath, cough elevated serum inflammatory markers, altered lymphocyte count, elevated AST, and low serum albumin. AA patients comprised a disproportionate share of COVID-19 death in the US during 2020 relative to other races/ethnicities.

Clinical correlates of circulating small dense low-density lipoproteins in acute infective endocarditis.

Infective endocarditis (IE) is a complex thrombo-inflammatory disorder, the pathogenesis of which involves a multifaceted interplay between vascular damage and bacterial virulence factors. This study aimed to assess the prognostic role of small dense low-density lipoprotein (sdLDL) cholesterol in patients with IE and its correlation with various disease-related features. A cohort of 198 patients with definite IE was included in this study. Clinical, laboratory, and echocardiographic parameters were meticulously analyzed, with a specific focus on comorbidities. sdLDL levels were measured using stored plasma samples obtained upon admission during the acute phase of the disease. The median level of sdLDL was 24mg/dL [with an interquartile range of 17.9-35.2mg/dL], and this value showed a statistically significant positive correlation with LDL/HDL cholesterol and triglycerides (p < 0.01 for all). Furthermore, a remarkable inverse correlation between C-reactive protein and D-dimer levels was observed (p < 0.0001). Univariate analysis revealed that patients with sdLDL levels ≤ 24mg/dL had 2.75 times higher odds of in-hospital mortality (95% Confidence Interval:1.08-6.98, p = 0.031). In addition, nonsurvivors had significantly lower median sdLDL levels (19.7 vs. 26.0mg/dL, p = 0.041). Lower sdLDL levels were also associated with embolic complications, larger vegetation size, and positive blood cultures for Staphylococci (p = 0.019, p = 0.022, and p < 0.001, respectively). Low circulating sdLDL levels in the acute phase of IE were significantly correlated with unfavorable clinical outcomes. These results suggest that the sdLDL level may serve as an important marker of disease severity in IE and may represent a link between vascular damage, embolic complications, and disease progression.

Transcatheter left atrial appendage occlusion in patients with chronic kidney disease: a systematic review and meta-analysis.

Chronic kidney disease (CKD) is a risk factor for embolic stroke, and many nonvalvular atrial fibrillation (NVAF) patients have concomitant CKD. Anticoagulation therapy can be challenging in CKD due to increased bleeding risk, and left atrial appendage occlusion (LAAO) may be a promising alternative. This systematic review aimed to consolidate current evidence on the safety and effectiveness of transcatheter LAAO in patients with CKD and end-stage renal disease (ESRD). Medline, Cochrane, and Embase databases were searched from inception to September 2, 2022. We conducted a meta-analysis if an outcome was evaluated in at least two similar studies. We included 15 studies with 77,780 total patients. Of the 15 studies, 11 had a cohort design (five prospective and six retrospective), and four were case series. Patients with CKD were older and had a higher prevalence of comorbidities than non-CKD patients. The two groups did not differ in procedural failure rate, vascular complications, or pericardial tamponade. CKD patients exhibited higher odds of in-hospital acute kidney injury (AKI) and bleeding, longer-term bleeding, and mortality than those without CKD. The risk of in-hospital and longer-term cardioembolic events was similar between CKD and non-CKD populations (odds ratio = 1.01 [95% CI 0.70-1.15] and 1.05 [95% CI 0.55-2.00], respectively). Patients with ESRD had higher odds of in-hospital mortality and cardioembolic events than non-ESRD patients, with no differences in risk of pericardial tamponade. Based on observational studies, LAAO may be an effective option to prevent cardioembolic events in CKD. However, CKD patients may have higher odds of AKI and in-hospital and long-term bleeding and mortality. The adverse clinical outcomes observed in CKD patients may be attributed to this population's high burden of comorbidities, especially among those with ERSD, rather than the LAAO procedure itself. To ensure maximum clinical benefit, careful patient selection, management, and surveillance involving multidisciplinary teams are essential for CKD patients undergoing LAAO. Transcatheter Left Atrial Appendage Occlusion (laao) Can Prevent Cardioembolic Events In Chronic Kidney Disease (ckd) Patients. However, Ckd Patients, Particularly Those With End-stage Renal Disease/dialysis (esrd), May Face Increased Odds Of Acute Kidney Injury, In-hospital And Long-term Bleeding, And Mortality. Notably, These Adverse Outcomes In Ckd Patients May Be Linked To Their High Comorbidity Burden, Particularly In Those With Esrd, Rather Than The Laao Procedure Itself. Careful Patient Selection, Management, And Surveillance Involving Multidisciplinary Teams Are Essential For Ckd Patients Undergoing Laao To Ensure Maximum Clinical Benefit Transcatheter left atrial appendage occlusion (LAAO) can prevent cardioembolic events in chronic kidney disease (CKD) patients. However, CKD patients, particularly those with end-stage renal disease/dialysis (ESRD), may face increased odds of acute kidney injury, in-hospital and long-term bleeding, and mortality. Notably, these adverse outcomes in CKD patients may be linked to their high comorbidity burden, particularly in those with ESRD, rather than the LAAO procedure itself. Careful patient selection, management, and surveillance involving multidisciplinary teams are essential for CKD patients undergoing LAAO to ensure maximum clinical benefit.

Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis

ABSTRACT Introduction Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, can be complicated by shock. The outcomes of patients with TTS complicated with cardiogenic shock (CS) versus mixed cardiogenic and septic shock (MS) is not known. Methods We queried Nationwide Inpatient Sample (NIS) from 2009–2020 to compare TTS patients with CS and MS using International Classification of Disease, Ninth & Tenth Edition, Clinical Modification (ICD- 9 & 10-CM) coding. In-hospital outcomes were compared using one: one propensity score matched (PSM) analysis. The primary outcome was in-hospital mortality. Results Of 23,126 patients with TTS 17,132 (74%) had CS, and 6,269 (26%) had MS. The mean age was 67 years in CS and 66 years in MS, and majority of patients were female (n = 17,775, 77%). On adjusted multivariate analysis, MS patients had higher odds of in-hospital mortality (aOR 1.44, 95% CI 1.36–1.52), AKI (aOR 1.53, 95% CI 1.48–1.58), pressor requirement (aOR 1.37, 95% CI 1.25–1.50). However, had lower odds of MCS use (aOR 0.44, 95% CI 0.40–0.48) and cardiac arrest (aOR: 0.81, 95% CI 0.73–0.90) (p-value <0.0001). Mean LOS and inflation-adjusted hospital charges were higher in MS. Conclusion MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.

Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis.

Disparities in venous thromboembolism (VTE) incidence and prophylaxis have been observed across racial groups. This study investigates the relationship between race, injury type, and the timing of VTE prophylaxis in severe trauma patients, both with and without isolated traumatic brain injuries. The primary goal is to analyze how these factors interact and their potential impact on clinical outcomes. A retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) from 2018 to 2021. Patient demographics, injury categories, VTE prophylaxis timing, injury severity, and in-hospital complications were collected. Multivariable regression models explored associations between race, injury type, VTE prophylaxis, and in-hospital mortality. Groups were analyzed by injury profile (isolated TBI vs non-TBI) and then by VTE prophylaxis timing (early ≤24hours, late >24hours). Of 68,504 trauma patients analyzed, the majority were non-Hispanic or Latino (83.3%), White (71.2%), and male (69.6%). Patients receiving late VTE prophylaxis had higher rates of DVT and PE across race groups than patients with early prophylaxis. Logistic regression showed Asian patients with TBI receiving early prophylaxis were significantly more likely to have in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04) than other races. Patients who received late prophylaxis had higher VTE rates than early prophylaxis, independent of injury pattern or race. Additionally, assessing the implications of race in early VTE prophylaxis for isolated TBI showed that adult Asian patients had 16 times higher odds of in-hospital mortality compared to other races.

Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation.

Although not formalized into current risk assessment models,frailtyhas been associated with negative postoperative outcomes in many specialties. However, national analyses of the association between frailty and post-transplant outcomes following kidney transplantation (KT) are lacking. This was a retrospective cohort study of adults undergoing KT from 2016 to 2020 in the Nationwide Readmissions Databases. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator. Of an estimated 95765 patients undergoing KT during the study period, 4918 (5.1%) were frail. After risk adjustment, frail patients were associated with significantly higher odds of in-hospital mortality (AOR 2.17, 95% CI: 1.33-3.57) compared totheir non-frail counterparts. Our findings indicate that frail patients had an average increase in postoperative hospital stay of 1.44 days, a $2300 increase in hospitalization costs, as well as higher odds of developing a major perioperative complication as compared to their non-frail counterparts. Frailty was also associated with greater adjusted risk of non-home discharge. Frailty, as identified by administrative coding, is independently associated with worse surgical outcomes, including increased mortality and resource use, in adults undergoing KT. Given the already limited donor organ pool, novel efforts are needed to ensure adequate optimization and timely post-transplantation care of the growing frail cohort undergoing KT.

Impact of COVID 19 on Patients with Multiple Myeloma : A National Inpatient Sample Analysis

Introduction: Multiple myeloma (MM) is characterized by the proliferation of clonal immunoglobulins and suppression of normal immunoglobulins. These patients are susceptible to infections due to multiple factors such as hypogammaglobulinemia, impaired lymphocyte function, steroid-related immunosuppression, and neutropenia secondary to chemotherapy. There is limited data on the association of COVID-19 infection with in-hospital outcomes of MM. We hypothesize that COVID-19 infection is associated with adverse outcomes. Methodology: We queried the National Inpatient Sample (NIS) Database 2020 for adult (aged ≥ 18 years) hospitalizations with a primary diagnosis of MM. The cohort was subcategorized based on the presence of COVID-19 infection. The primary outcome studied was in-hospital mortality. Multiple secondary outcomes were analyzed including length of stay, cost of hospital stay, and individual organ system failures. Multivariable logistic regression was performed adjusting for patient and hospital level characteristics to evaluate outcomes. An alpha error of 0.05 was accepted for all analyses. Results: A total of 111,540 MM hospitalizations were included in the study, of which 2,195 (1.96%) had concomitant COVID-19 infection. The mean age was almost similar in both groups. Patients with MM and concurrent COVID-19 infection, had significantly higher in-hospital mortality [adjusted odds ratio (aOR) 6.54, 95% CI 5.25-8.20, p&amp;lt;0.001], length of stay [aOR 4.12 (2.92-5.32), p&amp;lt;0.001] and hospitalization cost [$54,940 ($34,688-$75,191), p&amp;lt;0.001]. They had higher rates of cardiac arrest (2.9% vs 1.1%, p&amp;lt;0.001), acute renal failure (48.8% vs 31.3%, p&amp;lt;0.001), acute liver failure (2.5 % vs 1.1%, p&amp;lt;0.001), acute respiratory failure (50.8% vs 17.3%, p&amp;lt;0.001). They also required higher levels of care in terms of hemodialysis (14.8% vs 8.8%, p&amp;lt;0.001), non-invasive ventilation (8.4% vs 3.3%, p&amp;lt;0.001), and invasive ventilation (1.6 % vs 0.3%, p&amp;lt;0.001). Discussion: Patients with MM who were admitted with COVID-19 had higher odds of in-hospital mortality, and developing (end-organ)complications such as cardiac arrest, respiratory failure, renal failure, and liver failure. They also had longer and costlier stays. The development of COVID-19 in patients with MM causes such poor outcomes likely due to shared endothelial dysfunction, thrombosis, and hyperinflammation. Prior studies have also shown impaired response to mRNA vaccination in this population. Thus, as COVID-19 restrictions are now at ease, increased vigilance is required in this vulnerable population. The limitations of our study are retrospective use of the administrative database with a potential of missing or inaccurate data, lack of information on specific treatments in MM patients limiting the ability to assess treatment-related outcomes, and unknown vaccination status.

The Determinants of Inpatient Palliative Care Use in Patients With Pancreatic Cancer.

Symptom burden management is a major goal of pancreatic cancer care given that most patients are diagnosed late. Early palliative care is recommended in addition to concurrent active treatment; however, disparities exist. We sought to determine the factors associated with inpatient palliative treatment among pancreatic cancer patients and compare treatment outcomes in terms of mortality, discharge disposition and resource utilization. We conducted a retrospective study of 22,053 pancreatic cancers using the National Inpatient Sample (NIS) database (January - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on palliative treatment. Multivariate regression was used to evaluate patient and hospital characteristics and outcomes associated with palliative treatment. A total number of 3839 (17.4%) patients received palliative care. Patients who received palliative care were more likely to be older, Medicaid insured, and nonobese. Patients were less likely to receive palliative care if they are males, Medicare insured, had a lower Charlson comorbidity score, or treated in Urban nonteaching hospitals. Patients who received palliative care displayed higher odds of in-hospital mortality and prolonged LOS. The adjusted additional mean hospital cost and charges in patients who received palliative care were lower by $1459, and $4222 respectively. Inpatient palliative treatment in pancreatic cancer patients is associated with an older age, a higher comorbidity burden, non-obesity, insurance status and urban teaching hospitals. Our study suggests that inpatient palliative treatment decreased hospital resource utilization without prolonging survival.

Impact of systemic lupus erythematosus on outcomes in patients hospitalized with acute decompensated heart failure with reduced and preserved ejection fraction: a national inpatient sample study (2016)

Abstract Background Systemic lupus erythematosus (SLE) is known to have an impact on cardiovascular outcomes, but its effect on patients with acute decompensated heart failure (ADHF) with reduced and preserved ejection fraction is not well understood. This study aims to investigate the impact of SLE on in-hospital outcomes in patients with ADHF. Methods This retrospective cohort study analyzed data from the United States National Inpatient Sample Database from 2016 to 2020. Patients hospitalized with ADHF with reduced and preserved ejection fraction were identified using ICD-10 codes and then categorized based on SLE diagnosis. Mortality and in-hospital complications were analyzed using multivariate logistic regression. Results Out of 10,700,000 ADHF hospitalizations, 0.61% (65,270) were associated with SLE. Compared to patients without SLE, those with SLE were younger (61 vs 72 years old, p&amp;lt;0.001), more likely to be female (85% vs 48%, p&amp;lt;0.001), had longer lengths of stay (coefficient: 0.23; p 0.005), and lower total hospital charges (coefficient: -$5,207; p&amp;lt;0.001). Patients with SLE had lower rates of cardiogenic shock, acute MI, and ischemic stroke (Figure 1). However, they had higher odds of in-hospital mortality, gastrointestinal bleeding, blood transfusion, pericardial complications, and AKI. No significant differences were found in respiratory failure and intracranial hemorrhage rates between the two cohorts. Conclusions This study suggests that the presence of SLE in patients hospitalized with ADHF is associated with worse in-hospital outcomes, including higher rates of all-cause mortality, gastrointestinal bleeding, blood transfusion, pericardial complications, and AKI. However, patients with SLE had lower rates of cardiogenic shock, acute MI, and ischemic stroke compared to those without SLE. These findings highlight the importance of early recognition and aggressive management of SLE in patients with ADHF to improve outcomes. Further research is needed to identify potential interventions that could improve the outcomes of this high-risk population.

Temporal trends and outcomes of heart failure patients between light-chain cardiac amyloidosis and transthyretin cardiac amyloidosis: insights from the national inpatient sample database

Abstract Background Systemic amyloidosis comprises a family of diseases caused by deposition of misfolded fibrillar proteins in the extracellular space. Cardiac involvement is the leading cause of morbidity and mortality in systemic amyloidosis and a major determinant of survival, regardless of the underlying pathogenesis of amyloid production. Data regarding the clinical outcomes in immunoglobulin light-chain (AL) va amyloid transthyretin (ATTR) cardiac amyloidosis (CA) is scarce. Purpose We aimed to investigate the trends, baseline clinical characteristics, and clinical outcomes of AL CA vs ATTR CA in heart failure (HF) patients. Methods Data from United States National Inpatient Sample database from 2017-2020 was used to identify hospitalizations for CA with concurrent cardiomyopathy in HF patients and were further subclassified into AL vs ATTR CA. Outcomes were compared using univariate and multivariate logistic regression analysis. Results During 2017-2020, there were 12430 hospitalizations of CA of which 96.3% were ATTR CA and 3.7% were AL CA. Patients with ATTR-CA when compared to AL-CA were older, predominantly male, more blacks, and had a higher prevalence of co-morbidities including atrial arrythmias, sick sinus syndrome, and aortic stenosis. Patients with AL CA had significantly increased in-hospital mortality, length of stay, total charges, acute heart failure exacerbations, and cardiopulmonary resuscitation. After adjustment for baseline characteristics, AL CA patients had significantly increased odds of in-hospital mortality and HF hospitalizations when compared to ATTR CA cohort. There is an increasing trend in hospitalizations in AL CA from 2017-2019. Conclusion AL cardiac amyloidosis had significantly higher odds of in-hospital mortality and HF hospitalizations in comparison to ATTR cardiac amyloidosis cohort. AL CA had lower incidence of stroke, thromboembolism and major bleeding with similar need for cardiac device implantation.Figure 1Figure 2

Abstract 16086: Impact of Amyloidosis on the Outcomes of Percutaneous Coronary Intervention Recipients: A Nationwide Analysis

Background: Interest in amyloidosis is increasing, primarily due to its high prevalence and recent advances in diagnostic and treatment modalities. The role of amyloidosis in aortic stenosis is established, and in coronary artery disease (CAD) outcomes are being reported. We aim to study the impact of amyloidosis on the outcomes of inpatient percutaneous coronary intervention (PCI) recipients. Methods: We conducted a cross-sectional cohort study using the nationwide inpatient sample (NIS) 2018-19. We included 457,730 adult inpatients with CAD managed with PCI and further divided by the presence of a co-diagnosis of amyloidosis. A logistic regression model was used to evaluate the odds ratio (OR) of the association between amyloidosis and various outcomes in PCI recipients.Results: Out of the total of 457,730 patients included, 30,905 (6.75%) had amyloidosis. Mean age (66.3 vs. 65.9), female sex (35.6% vs. 32.1%), and African American race (11.6% vs. 9.4%) were higher in the amyloidosis cohort (all P&lt;0.001). The amyloidosis cohort also had a higher incidence of acute kidney injury (AKI) (29.9% vs. 15.5%), complications of surgical care (1.7% vs. 0.7%), complications of cardiovascular implant (9.5% vs. 8.5%), major loss of function (54.7% vs. 27.8%), length of stay (LOS) in days (6.3 vs. 3.8), total charges in $ (166,001 vs. 121,718), and in-hospital mortality (4.7% vs. 2.6%) compared to non-amyloidosis cohort (all P&lt;0.001). Amyloidosis was associated with higher odds of in-hospital mortality (OR 1.3, 95CI 1.23-1.39, p&lt;0.001), AKI (OR 1.89, 95CI 1.83-1.94, p&lt;0.001), and complications of surgical care (OR 2.05, 95CI 1.87-2.26, p&lt;0.001) but not with complications of cardiovascular implant (OR 1.01, 95CI 0.97-1.05, p=0.703). Conclusions: Amyloidosis is associated with worse outcomes in inpatient recipients of PCI. Further studies are needed to assess the implications, safety, and outcomes of elective PCI in patients with amyloidosis.

Abstract 13973: Amyloidosis and Heart Failure is a Deadly Combination: A Retrospective Study From 2015-2019 Using the National Inpatient Sample

Introduction: Heart failure (HF) is a common cause of hospitalization in the United States. Amyloidosis has become a more accepted cause of HF in the US however contemporary data on amyloidosis affecting the heart is relatively lacking even in the setting of increased mortality and morbidity rates. This study is aimed to define the prevalence of HF in amyloidosis along with looking at inpatient mortality, length of stay and other relevant factors. Methods: For the current study, the National Inpatient Sample (NIS) was queried for the years 2015 Q4-2019. Our cohort of interest included patients with amyloidosis. We further identified patients with heart failure using the ICD-10 diagnosis codes algorithm for Elixshauser comorbidity scoring. Results: A total of 23,586 patients were identified with amyloidosis between 2015 Q4 and 2019. Interestingly, 49% of those patients (11,560 people) were identified with a diagnosis of HF, reflecting its increased prevalence in patients with amyloidosis. The mean age of the cohort was 71.9 years (SD=12.3), Patients with heart failure were overall more likely to be males (63.7% vs 50.2%, p&lt;0.001), and were more likely to be African American (30.4% vs 16.2%, overall p&lt;0.001), compared to patients without heart failure. When compared to amyloidosis subjects without HF, those with HF experienced an increased rate of mortality (7.2% vs 5.5%, p&lt;0.001), a longer length of stay (LOS) with a mean difference of 0.7 days (7.9 days vs 7.2 days, p&lt;0.001), and a more costly overall hospitalization with a mean difference of $10,906.1 ($90159.3 vs $79253.2, p&lt;0.001). Upon multivariable logistic regression analysis, the presence of HF (OR 1.24, 95%CI 1.11-1.401, p&lt;0.001) was associated with higher odds of in-hospital mortality. Conclusions: Our study shows that HF is a dominant comorbidity in patients with amyloidosis with almost every other patient being affected. Additionally, when compared to those without HF, patients with HF were more likely to be African American, have a longer length of stay, have more costly admissions, and overall had a higher rate of in-patient mortality.

Abstract 14620: Association of Rural Residence With In-Hospital Mortality for Heart Failure Hospitalizations in Texas: A Population-Based Cohort Study

Background: Rural residents with heart failure may be at higher risk of mortality due to disparities in access to health care services. Patterns of urban-rural disparity in health care resources may vary across the United States and population level analyses of the impact of rural residence on hospitalized patients with heart failure in Texas are not conclusive. Hypothesis: Rural residence is associated with increased risk of in-hospital mortality in patients with heart failure. Methods: We used publicly available, statewide, and deidentified hospitalization records to study patients aged ≥18 years with heart failure as principal diagnosis in Texas for years 2016 through 2021. Three models estimated the association between rural residence and in-hospital mortality. Multilevel logistic regression with propensity adjustment was the primary analysis approach with propensity score matching and multivariable logistic regression without propensity score matching applied as alternative analyses. Additional analyses were completed for patient subgroups and for categories of heart failures. Results: Out of 460,798 heart failure hospitalizations (HFH), 61,480 (13.3%) were classified as rural residents. HFH with vs without rural residence were older (70.4% vs 64.8% aged ≥ 65years), more often white (63.5% vs 46.9%), less frequently had private insurance (26.2% vs 35.4%) and were less often admitted to teaching hospitals (19.5% vs 28.9%); p &lt; 0.0001 for each. Unadjusted in-hospital mortality among HFH with and without rural residence was 2.5% vs 2.1%. On adjusted analyses, rural residence remained associated with higher odds of in-hospital mortality (adjusted odds ratio 1.1685 (95% CI [1.0878 - 1.2554]). The results were similar for the alternative modeling approaches, subgroup analyses, and categories of heart failures. Conclusions: Rural residence in Texas was associated with higher risk of in-hospital mortality in patients with heart failure.

Abstract 16042: Sex/Gender Specific Differences in the Outcomes of Ventricular Arrhythmias Complicating Acute Myocardial Infarction

Introduction: Ventricular Arrythmias (VA) is a common clinical problem in myocardial ischemia and the most common cause of sudden death in patients with Acute Myocardial Infarction (AMI). Studies have shown sex differences in the incidence, presentation, and outcomes of AMI. However, evidence on the sex differences in VA in patients with AMI is limited. In this study we evaluated the sex differences in the incidence and in- hospital outcomes of VA in patients who were admitted with AMI. Methods: Using the NIS 2016 - 2020, we retrospectively analyzed the data of patients admitted for AMI using the ICD 10 code (I21). Our primary population included patients who underwent reperfusion (PCI or CABG), 18 years and above, and had a secondary diagnosis of either Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT). We excluded patients who had infiltrative cardiac diseases (Sarcoidosis, Lyme disease, amyloidosis) or long QT syndrome. We further divided our sample population into 2 groups based on their reported gender (Male or Female). Using a multivariate analysis, we compared the odds of VA and in-hospital outcomes between both subgroups of patients. Results: We identified 174,565 patients with VA in the setting of AMI. Of these 75.8% were males. VF was observed in 15,500 (36.4%) of female patients and 45,010 (34%) of male patients. The odds of VA after AMI were higher in Men (AOR): 1.72, CI: 1.67 - 1.78, p&lt;0.001). Male patients were more likely to have a history of myocardial infarction, smoking and Cocaine use while female patients were more likely to have DM, PVD and heart failure. Female patients had significantly higher odds of in-hospital mortality (AOR: 1.32, CI: 1.21 - 1.42, p&lt;0.001), cardiogenic shock (AOR: 1.08, CI: 1.01 - 1.15, p&lt;0.022) and Cardiac arrest (AOR:1.11, CI: 1.03 - 1.18, p&lt;0.002). However, they had significantly lower odds of defibrillator insertion (AOR: 0.57, CI: 0.47 - 0.68, p&lt;0.001) or catheter ablation (AOR: 0.51, CI: 0.27 - 0.98, p&lt;0.001) during the index admission. Conclusion: There are sex differences in the incidence and outcomes of VA in AMI, with women having lower odds of VA but worse hospital outcomes. Incorporation of women in more VA studies and may help us understand why these differences in outcomes exists

Association of frailty with postoperative outcomes following thoracic transplantation: A national analysis

ObjectiveFrailty has been repeatedly associated with inferior outcomes after surgical hospitalizations. However, a thorough evaluation of the impact of frailty on the clinical and financial outcomes of patients undergoing solid-organ thoracic transplantation is sparse in the literature. We evaluated the association of frailty, as determined by an administrative tool, with postoperative outcomes and healthcare resource use after heart or lung transplantation. MethodsThe Nationwide Readmissions Database was used to identify all adult hospitalizations for heart or lung transplant from 2014 to 2020. Patients were grouped as frail or nonfrail using International Classification of Diseases codes associated with conditions in the Johns Hopkins Adjusted Clinical Groups cluster. Multivariable regression models were developed to evaluate the association of frailty status on in-hospital mortality, complications, length of stay, costs, and unplanned readmissions. ResultsOf an estimated 35,862 heart or lung transplant recipients, 7316 (20.4%) were considered frail. After multivariable adjustment, frailty in heart transplantation was associated with greater odds of in-hospital mortality (adjusted odds ratio, 1.54; 95% CI, 1.19-1.99) and infectious complications (adjusted odds ratio, 1.77; 95% CI, 1.45-2.15; P < .001). Frailty in lung transplantation was also associated with higher odds of in-hospital mortality (adjusted odds ratio, 1.38; 95% CI, 1.11-1.69) and infectious complications (adjusted odds ratio, 1.93; 95% CI, 1.60-2.31). In addition, frailty in both heart transplantation and lung transplantation was associated with increased postoperative length of stay and greater costs. ConclusionsAmong transplant recipients, those classified as frail were associated with increased in-hospital mortality, perioperative complications, and resource use.

Impact of Body Mass Index on outcomes in hospitalized heart failure patients with reduced versus preserved ejection fraction: a 1,699,494-individual analysis from the United States National Inpatient Sample.

Obesity's effect on outcomes in heart failure (HF) patients with reduced versus maintained ejection fraction (HFrEF and HFpEF) remains debatable. We evaluated hospital outcomes and healthcare expenditures in these patients based on their Body Mass Index (BMI). Using the USA National Inpatient Sample (NIS) database, patients >18 years admitted with a primary diagnosis of HFrEF or HFpEF between January 1, 2004, and August 31, 2015, were studied. Patients were stratified into the following BMI categories: underweight, normal weight, overweight, obese, and morbidly obese. Adjusted multivariable analyses using Poisson regression models were used to study the association between BMI and hospital outcomes and healthcare costs. Overall, 1,699,494 patients were included. After full adjustment, obesity (OR=1.84; 95% CI: 1.22-2.76) and morbid obesity (OR=1.81; 95% CI: 1.22-2.70) increased the odds of in-hospital mortality compared with normal weight. When stratified per ejection fraction, underweight patients had higher odds of in-hospital mortality in HFrEF (OR=1.46; 95% CI: 1.06-2.01). Obese and morbidly obese patients had higher odds of in-hospital mortality in both HFrEF and HFpEF. Furthermore, obese and morbidly obese patients had a longer mean adjusted length of stay and higher health care expenses. Being underweight is associated with increased risk of in-hospital mortality in HFrEF patients. Obesity and morbid obesity increase the risk of in-hospital mortality and higher healthcare costs in both HFrEF and HFpEF. These findings have clinical significance for HF patients, and further research is needed to investigate the ideal weight for HF patients.