United States National Inpatient Sample Research Articles

Racial Disparities in Cardiovascular and Cerebrovascular Adverse Events in Patients with Non-Hodgkin Lymphoma: A Nationwide Analysis.

Background and Objectives: Non-Hodgkin lymphoma (NHL) has the sixth-highest malignancy-related mortality in the United States (US). However, inequalities exist in access to advanced care in specific patient populations. We aim to study the racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) in NHL patients. Materials and Methods: Using ICD-10 codes, patients with NHL were identified from the US National Inpatient Sample 2016-2019 database. Baseline characteristics, comorbidities, and MACCE outcomes were studied, and results were stratified based on the patient's race. Results: Of the 777,740 patients with a diagnosis of NHL, 74.22% (577,215) were White, 9.15% (71,180) were Black, 9.39% (73,000) were Hispanic, 3.33% (25,935) were Asian/Pacific Islander, 0.36% (2855) were Native American, and 3.54% (27,555) belonged to other races. When compared to White patients, all-cause mortality (ACM) was significantly higher in Black patients (aOR 1.27, 95% CI 1.17-1.38, p < 0.001) and in Asian/Pacific Islander patients (aOR 1.27, 95% CI 1.12-1.45, p < 0.001). Sudden cardiac death was found to have a higher aOR in all racial sub-groups as compared to White patients; however, it was statistically significant in Black patients only (aOR 1.81, 95% CI 1.52-2.16, p < 0.001). Atrial fibrillation (AF) risk was significantly lower in patients who were Black, Hispanic, and of other races compared to White patients. Acute myocardial infarction (AMI) was noted to have a statistically significantly lower aOR in Black patients (0.70, 95% CI 0.60-0.81, p < 0.001), Hispanic patients (0.69, 95% CI 0.59-0.80, p < 0.001), and patients of other races (0.57, 95% CI 0.43-0.75, p < 0.001) as compared to White patients. Conclusions: Racial disparities are found in MACCEs among NHL patients, which is likely multifactorial, highlighting the need for healthcare strategies stratified by race to mitigate the increased risk of MACCEs. Further research involving possible epigenomic influences and social determinants of health contributing to poorer outcomes in Black and Asian/Pacific Islander patients with NHL is imperative.

Critical care outcomes in decompensated cirrhosis: a United States national inpatient sample cross-sectional study

BackgroundPrior assessments of critical care outcomes in patients with cirrhosis have shown conflicting results. We aimed to provide nationwide generalizable results of critical care outcomes in patients with decompensated cirrhosis.MethodsThis is a retrospective study using the National Inpatient Sample from 2016 to 2019. Adults with cirrhosis who required respiratory intubation, central venous catheter placement or both (n = 12,945) with principal diagnoses including: esophageal variceal hemorrhage (EVH, 24%), hepatic encephalopathy (58%), hepatorenal syndrome (HRS, 14%) or spontaneous bacterial peritonitis (4%) were included. A comparison cohort of patients without cirrhosis requiring intubation or central line placement for any principal diagnosis was included.ResultsThose with cirrhosis were younger (mean 58 vs. 63 years, p < 0.001) and more likely to be male (62% vs. 54%, p < 0.001). In-hospital mortality was higher in the cirrhosis cohort (33.1% vs. 26.6%, p < 0.001) and ranged from 26.7% in EVH to 50.6% HRS. Mortality when renal replacement therapy was utilized (n = 1580, 12.2%) was 46.5% in the cirrhosis cohort, compared to 32.3% in other hospitalizations (p < 0.001), and was lowest in EVH (25.7%) and highest in HRS (51.5%). Mortality when cardiopulmonary resuscitation was used was increased in the cirrhosis cohort (88.0% vs. 72.1%, p < 0.001) and highest in HRS (95.7%).ConclusionsOne-third of patients with cirrhosis requiring critical care did not survive to discharge in this U.S. nationwide assessment. While outcomes were worse than in patients without cirrhosis, the results do suggest better outcomes compared to previous studies.

Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States: A Cross-sectional Cohort Study.

This study aims to investigate associated mortality with inpatient endoscopic retrograde cholangiopancreatography (ERCP) with and without resistant infections. The co-primary objective compares frequencies of inpatient ERCP with resistant infections to overall hospitalizations with resistant infections. The risks of inpatient antibiotic-resistant organisms are known, but the associated mortality for inpatient ERCP is unknown. We aim to use a national database of hospitalizations and procedures to understand trends and mortality for patients with antibiotic-resistant infections during inpatient ERCP. The largest publicly available all-payer inpatient database in the United States (National Inpatient Sample) was used to identify hospitalizations associated with ERCPs and antibiotic-resistant infections for MRSA, VRE, ESBL, and MDRO. National estimates were generated, frequencies were compared across years, and multivariate regression for mortality was performed. From 2017 to 2020, national weighted estimates of 835,540 inpatient ERCPs were generated, and 11,440 ERCPs had coincident resistant infections. Overall resistant infection, MRSA, VRE, and MDRO identified at the same hospitalization of inpatient ERCPs were associated with higher mortality (OR CI(95%): Overall: 2.2(1.77-2.88), MRSA: 1.90 (1.34-2.69), VRE: 3.53 (2.16-5.76), and MDRO: 2.52 (1.39-4.55)). While overall hospitalizations with resistant infections have been decreasing annually, there has been a yearly increase in admissions requiring ERCPs with simultaneous resistant infections ( P =0.001-0.013), as well as infections with VRE, ESBL, and MDRO ( P =0.001-0.016). Required Research Practices for Studies Using the NIS scoring was 0, or the most optimal. Inpatient ERCPs have increasing coincident resistant infections and are associated with higher mortality. These rising infections during ERCP highlight the importance of endoscopy suite protocols and endoscopic infection control devices.

Risk of respiratory diseases among hospitalized patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease. This is a cross-sectional, case-control, population-based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD-9-CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls. Twenty-three thousand seven hundred and sixty-seven hospital admissions for HS were compared with 95,068 age- and sex-matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170-1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419-1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157-2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182-1.374]; P < 0.001). HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients.

Pediatric neurosurgical medulloblastoma outcomes in La Paz, Bolivia: How a Lower Middle-Income Country (LMIC) institution in South America compares to the United States.

How pediatric medulloblastoma patients fare in Lower Middle-Income Country (LMICs) in South America is not well understood. Correspondingly, the aim of this study was to summarize the pediatric neurosurgical experience of an institution in La Paz, and compare outcomes to that of a generalized High Income Country (HIC) United States (US) experience. A retrospective review of all pediatric neurosurgical medulloblastoma patients at the Children's Hospital of La Paz, Bolivia (Hospital del Niño "Dr. Ovidio Aliaga Uria") between 2014 and 2023 was conducted and compared to a generalized US experience abstracted from the US National Cancer Database (NCDB) and National Inpatient Sample (NIS) databases. Categorical, continuous and survival data were statistically summarized and compared. A total of 24 pediatric medulloblastoma patients underwent neurosurgical treatment at the Hospital del Niño. In this La Paz cohort, there were 15 (63%) males and 9 (38%) females, with a mean age of 5.6 years old at diagnosis. The majority of patients underwent subtotal resection (STR, 79%), while the remaining patients underwent biopsy only. Ten (42%) patients expired during their hospitalization, and mean length of stay overall was 39 days. Only 8 (33%) patients received adjuvant treatment after surgery. Median overall survival from diagnosis in the La Paz cohort was 1.9 months. Compared to the US databases, the La Paz cohort experienced significantly more emergency room admissions for surgery, less gross total resection, more STR, more return to operating room for ventriculoperitoneal shunting, more bacteremia, more tracheostomy procedures, more percutaneous gastrostomy placements, longer lengths of stay, less adjuvant chemotherapy, less radiation therapy, shorter follow-up, and ultimately, significantly shorter overall survival (all P < 0.050). Pediatric neurosurgical medulloblastoma outcomes at the Children's Hospital of La Paz, Bolivia are significantly inferior to that of a generalized US experience. Future research is required to identify institution- and country-specific initiatives to improve discrepancies between institutions in LMICs in South America compared to HICs.

Short-Term Outcomes of Conventional Laparoscopic versus Robot-Assisted Distal Pancreatectomy for Malignancy: Evidence from US National Inpatient Sample, 2005-2018.

The primary treatment for pancreatic cancer is surgical resection, and laparoscopic resection offers benefits over open surgery. This study aimed to compare the short-term outcomes of robot-assisted vs. conventional laparoscopic distal pancreatectomy. Data of adults ≥ 20 years old with pancreatic cancer who underwent conventional laparoscopic or robot-assisted laparoscopic distal pancreatectomy were extracted from the United States (US) Nationwide Inpatient Sample (NIS) 2005-2018 database. Comorbidities and complications were identified through the International Classification of Diseases (ICD) codes. Short-term outcomes were compared using logistic regression and included length of hospital stay (LOS), perioperative complications, in-hospital mortality, unfavorable discharge, and total hospital costs. A total of 886 patients were included; 27% received robot-assisted, and 73% received conventional laparoscopic surgery. The mean age of all patients was 65.3 years, and 52% were females. Multivariable analysis revealed that robot-assisted surgery was associated with a significantly reduced risk of perioperative complications (adjusted odds ratio (aOR) = 0.61, 95% confidence interval (CI): 0.45-0.83) compared to conventional laparoscopic surgery. Specifically, robot-assisted surgery was associated with a significantly decreased risk of VTE (aOR = 0.35, 95% CI: 0.14-0.83) and postoperative blood transfusion (aOR = 0.37, 95% CI: 0.23-0.61). Robot-assisted surgery was associated with a significantly shorter LOS (0.76 days shorter, 95% CI: -1.43--0.09) but greater total hospital costs (18,284 USD greater, 95% CI: 4369.03-32,200.70) than conventional laparoscopic surgery. Despite the higher costs, robot-assisted distal pancreatectomy is associated with decreased risk of complications and shorter hospital stays than conventional laparoscopic distal pancreatectomy.

Clinical Features and Outcomes of Myxedema Coma in Patients Hospitalized for Hypothyroidism: Analysis of the United States National Inpatient Sample.

Background: Hypothyroidism is a common endocrine condition and chronic thyroid hormone deficiency is associated with adverse effects across multiple organ systems. In compensated hypothyroidism, however, patients remain clinically stable due to gradual physiological adaptation. In contrast, the clinical syndrome of decompensated hypothyroidism referred to as myxedema coma (MC) is an endocrine emergency with high risk of mortality. Because of its rarity, there are currently limited data regarding MC. This study analyzes the clinical features and hospital outcomes of MC compared with hypothyroid patients without MC (nonMChypo) in national United States hospital data. Methods: A retrospective analysis of the National Inpatient Sample, a public database of inpatient admissions to nonfederal hospitals in the United States, 2016-2018, including adult patients with primary diagnosis of MC (International Classification of Diseases 10th Revision [ICD-10]: E03.5) or nonMChypo (E03.0-E03.9, E89.0). Patient demographics, relevant clinical features, mortality, length of stay (LOS), and hospital costs were compared. Results: Of 18,635 patients hospitalized for hypothyroidism, 2495 (13.4%) had a diagnosis of MC. Sex distribution and race/ethnicity were similar between patients with MC and nonMChypo, whereas MC was associated with older patient age (p = 0.02), public insurance (p = 0.01), and unhoused status (p = 0.04). More admissions with MC occurred in winter compared with other seasons (p = 0.01). The overall mortality rate for MC was 6.8% versus 0.7% for nonMChypo (p < 0.001), and MC was independently associated with in-hospital mortality after adjusted regression analysis (adjusted odds ratio = 9.92 [CI 5.69-17.28], p < 0.001). Mean LOS ± standard error was 9.64 ± 0.73 days for MC versus 4.62 ± 0.12 days for nonMChypo (p < 0.001), and total hospital cost for MC was $21,768 ± $1759 versus $8941 ± $276 for nonMChypo (p = 0.07). In linear regression analyses, MC was an independent predictor of both increased LOS and total hospital cost. Conclusions: In summary, MC remains a clinically significant diagnosis in the modern era, independently associated with high mortality and health care costs. This continued burden demonstrates a need for further efforts to prevent, identify, and optimize treatment for patients with MC.

Sex and Age Characteristics in Acute or Chronic Myocarditis: A Descriptive, Multicenter Cohort Study

BackgroundUnderstanding the clinical features of myocarditis in various age groups is required to identify age-specific disease patterns. ObjectivesThe objective of this study was to examine differences in sex distribution and clinical outcomes in patients with myocarditis of various ages. MethodsPatients with acute or chronic myocarditis in 3 centers in Berlin, Germany from 2005 to 2021 and in the United States (National Inpatient Sample) from 2010 to 2019 were included. Age groups examined included “prepubescent” (below 11 years for females and below 13 years for males), adolescents (11 [female] or 13 [male] to 18 years), young adults (18-35 years), “middle-aged adults” (35-54 years), and older adults (age >54 years). In patients admitted to the hospital, hospital mortality, length of stay, and medical complication rates were examined. ResultsOverall, 6,023 cases in Berlin and 9,079 cases in the U.S. cohort were included. In both cohorts, there were differences in sex distribution among the 5 age categories, and differences in the distribution were most notable in adolescents (69.3% males vs 30.7% females) and in young adults (73.8% males vs 26.3% females). Prepubescent and older adults had the highest rates of in-hospital mortality, hospital length of stay, and medical complications. In the Berlin cohort, prepubescent patients had higher levels of leukocytes (P < 0.001), antistreptolysin antibody (P < 0.001), and NT-proBNP (P < 0.001) when compared to young adults. ConclusionsIn this study, we found that sex differences in myocarditis and clinical features of myocarditis were age-dependent.

Association between neighborhood household income and inpatient atrial fibrillation outcomes

BackgroundThe impact of socioeconomic status on the clinical outcomes of patients admitted to the hospital for atrial fibrillation (AF) is not well described. ObjectiveThe purpose of this study was to determine the association between median neighborhood household income (mNHI) and clinical outcomes among patients admitted to the hospital for AF. MethodsWe retrospectively analyzed primary AF hospitalizations from the United States National Inpatient Sample between 2016 and 2020. The analyzed sample was divided into quartiles based on the mNHI in the zip code of the patient’s residence. The lowest quartile was used as the reference category. Study outcomes included inpatient procedure utilization (ablation, cardioversion, percutaneous left atrial appendage closure), length of stay, cost, mortality, and disposition. Weighted multivariable logistic and linear regression, adjusting for multiple patient and hospital-level characteristics, was performed. ResultsPatients in the highest mNHI quartile had lower comorbidity burden, lower in-hospital mortality (odds ratio [OR] 0.78; 95% confidence interval [CI] 0.7–0.87; P <.001), lower discharges to care facility (OR 0.86; 95% CI 0.83–0.9; P <.001), shorter length of stay (adjusted mean difference –0.26; 95% CI –0.30 to –0.22; P <.001), higher procedure utilization, and higher health care costs ($12,124 vs $10,018) compared to the lowest mNHI quartile patients. ConclusionWe identified significantly higher in-hospital mortality and lower procedural/resource utilization in patients living in lower-income neighborhoods compared to higher-income neighborhoods. Further research is needed to better understand the drivers of these disparities and the strategies to improve health care disparities between socioeconomic groups.

Abstract TP172: Rising Trends in Cervical Artery Dissection Admissions: A Nationwide Study From 2005 to 2019

Introduction: A recent regional study suggested an upward trend in the incidence rates of spontaneous cervical artery dissection (sCAD). Utilizing a comprehensive nationwide database, we investigated these trends on a national scale. Method: We analyzed adult patients diagnosed with sCAD in the United States National Inpatient Sample database from 2005 to 2019, employing validated standard ICD-9 and ICD-10 diagnostic codes. By integrating the survey-weighted annual total of CAD cases with annual Census data, we estimated the incidence over the study period. The annualized percentage change (APC) over the study period was estimated using regression models and visually represented with an exponential regression line. Trends were further stratified by sex, age group, and race. Result: From 2005 to 2019, we identified 557,063,391 patients, of whom 125,102 (0.02%) had non-traumatic CAD. The incidence of CAD increased from 10.5 cases per million population in 2005 to 45.5 cases per million population in 2019 ( P &lt; 0.001), revealing a significant increase in admissions with CAD. Regression analysis estimated an APC of 9.6%, with a 95% CI of 8.4% to 10.7% (P &lt; 0.001) (Figure). This upward trend persisted across all strata of sex, age, and race. Conclusion: Our nationwide analysis demonstrates a significant rise in admissions with CAD from 2005 to 2019 across all demographic groups. The change in trend could be attributed to greater disease awareness leading to more frequent coding of CAD diagnoses, and/or to increased use of CT angiogram coinciding with the rise of mechanical thrombectomy for stroke. This underscores CAD's increasing clinical prevalence, warranting further investigation into its causes, prevention, and treatment.

Short-term postoperative outcomes for obese versus non-obese inflammatory bowel disease patients undergoing bowel resection: a propensity score matched analysis.

Up to 40% of patients with inflammatory bowel disease (IBD) are obese. Obesity is a well-known risk factor for increased perioperative morbidity, but this risk has never been quantified in IBD patients undergoing abdominal surgery using the United States National Inpatient Sample (NIS) database. This study aims to compare postoperative morbidity between obese and non-obese patients undergoing bowel resection for IBD using recent NIS data. Adult patients who underwent bowel resection for IBD from 2015 to 2019 were identified in the NIS using ICD-10-CM coding. Patients were stratified into obese (BMI > 30kg/m2) and non-obese groups, then propensity score matched (PSM) for demographic, operative, and hospital characteristics. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative complications, total admission healthcare costs, and length of stay (LOS). Univariable and multivariable regressions were utilized. Overall, 6601 non-obese patients and 671 obese patients were identified. The PSM cohort included 659 patients per group. Obese patients had significantly increased odds of experiencing postoperative in-hospital morbidity (aOR 1.50, 95% CI 1.10-2.03, p = 0.010) compared to non-obese patients. Specifically, obese patients experienced increased gastrointestinal complications (aOR 1.49, 95% CI 1.00-2.24, p = 0.050), and genitourinary complications (aOR 1.71, 95% CI 1.12-2.61, p = 0.013). There were no differences in total admission healthcare costs (MD - $2256.32, 95% CI - 19,144.54-14,631.9, p = 0.79) or LOS (MD 0.16days, 95% CI - 0.93-1.27, p = 0.77). Obese IBD patients are at greater risk of postoperative in-hospital morbidity than non-obese IBD patients. This supports targeted preoperative weight loss protocols for IBD patients to optimize surgical outcomes.

Comparative Analysis of Hospital Outcomes for Thrombotic Thrombocytopenic Purpura between 2018 and 20120: A National Inpatient Sample Database Study

Background: Thrombotic Thrombocytopenic Purpura (TTP) is a rare, life-threatening hematological emergency with a mortality rate of up to 20%. While plasma exchange and immunosuppression have long been the “pillars” of therapy, since 2019, a novel targeted therapy, caplacizumab, has become available. This study aims to analyze hospital outcomes before and after 2019 to assess the potential impact of this therapeutic advancement. Methods: A retrospective analysis of the United States (US) National Inpatient Sample (NIS) database was conducted using International Classification of Diseases (ICD-10) codes to identify TTP patients in 2018 and 2020. The data were analyzed using STATA version MP14.2. Fischer's exact test, student's t-test, and multivariate regression analysis were used to compare proportions and continuous variables and calculate the adjusted odds ratio. The database, however, did not consistently specify which patients received specific therapeutics like rituximab and caplacizumab and which patients did not. Results: The study included 1120 TTP hospitalization in 2018 and 975 in 2020. The majority of patients were African Americans (52.1% in 2018, 46.4% in 2020) and females (67.9% in 2018, 68.7% in 2020); 1.6% had COVID-19 infection in 2020, with a mean Charlson comorbidity Index (CCI) of 1.28 in 2018 vs. 1.34 in 2020. The multivariate analysis after controlling age, sex, CCI, and primary payer, revealed no significant change in the rates of stroke (AOR: 0.94, 95% CI: 0.64-1.40, P = 0.77), myocardial infarction (AOR: 1.01, 95% CI: 0.70-1.46, P = 0.95), acute kidney injury (AOR: 0.91, 95% CI: 0.72-1.14, P = 0.398), acute bleeding (AOR: 0.74, 95% CI: 0.51-1.09, P = 0.13), packed red blood cell transfusion (AOR: 0.95, 95% CI: 0.74-1.23, P = 0.71), and platelet transfusion (AOR: 1.20, 95% CI: 0.88-1.62, P = 0.25) in 2020 compared to 2018. Additionally, there were no significant changes in the mortality rate (AOR: 0.83, 95% CI: 0.52-1.33, P = 0.43) and mean length of hospital stay (12 vs. 11 days) in 2020. However, a significant increase in mean hospital cost ($189,749.9 vs. $267,835 US dollars, P&amp;lt;0.001), adjusted for inflation, was observed in 2020. A subgroup analysis was conducted for 50 patients who received caplacizumab in 2020, revealing higher average hospital costs ($465,665 vs. $241,665) and an increased rate of intracranial bleeding (10% vs. 1.6%) compared to patients whose caplacizumab usage was unknown. Mortality was observed in none of the known caplacizumab-treated samples, while 6.5% mortality was recorded among those without known caplacizumab use. Conclusion: Compared to 2018, 2020 hospitalizations had a substantial increase in costs without a significant change in patient outcomes. This probability is related to the COVID-19 pandemic and the advent of caplacizumab use in the US. We were unable to sort out the impact of other costly therapeutics like rituximab. However, it would be given less frequently. Further study is needed to explore this indirect inference from the NIS database analysis and the attendant cost-benefit implications in the management of TTP and its impact on patient outcomes.

1503. Impact of Sars-Cov-2 (Covid-19) in Patients Living with HIV from United States National Inpatient Sample Database

Abstract Background The COVID-19 pandemic has raised concerns about the impact on those living with HIV/AIDS due to weakened immune systems. Disruptions to HIV services and medication supplies caused by the pandemic have also raised concerns about increased HIV-related illnesses and deaths. An inpatient sample database was used to investigate the impact of Covid-19 on HIV patients in the US by examining the clinical outcomes of Covid-19 patients with and without HIV in US hospitals. Methods The NIS database is a publicly available and extensive database that contains information on millions of hospitalizations in the United States. Using the NIS 2020 database, adult patients who were diagnosed with COVID-19 were identified and categorized based on their HIV status. In order to examine the NIS database, a variety of statistical approaches were employed, such as univariate and multivariate analysis, descriptive statistics, and regression analysis. Results A total of 11,080 hospitalized HIV-positive patients were diagnosed with COVID-19. Amongst them, 7,510 were male and 3,570 were female with 23.1% being Caucasian, 50.8% African American, and 19.3% Hispanic. 47% of the patients had a national median household income between 0-25th percentile. Geographically, 27.8% were from the northeast, 19.4% from the midwest, 44.4% from the south, and 8.4% from the west. The most common comorbidities were hypertension at 32.8%, diabetes mellitus with complications at 27.8%, chronic lung disease at 26.7%, obesity at 22.2%, hypothyroidism at 7.6%, drug abuse at 8.6%, and depression at 14.5%. The mean age for patients with HIV who contracted COVID-19 was 56 years with a length of stay (LOS) of 9.7 days and an economic burden of $27,566 in comparison to patients without HIV, who had a mean age of 62 years, LOS of 7.9 days, and cost of $21,553. Data Analysis : Demographics Data Analysis: Comorbidities Data Analysis: Outcomes Conclusion In conclusion, hospitalized patients living with HIV, particularly African Americans, face a greater risk for adverse outcomes from COVID-19, which results in increased healthcare utilization. This underscores the need for safeguarding vulnerable populations and monitoring infectious disease spread. Further research is needed to better understand how COVID-19 affects different demographics and how to address their healthcare needs during pandemics. Disclosures All Authors: No reported disclosures

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

Investigating the impact of chronic heart failure on in-hospital outcomes following transcatheter mitral valve repair or replacement: a national inpatient sample study (2016-2020)

Abstract Background Chronic heart failure (CHF) is a global health problem and one of the primary causes of morbidity and mortality worldwide. Transcatheter mitral valve repair or replacement (TMVr or TMVR) is a procedure that has demonstrated improved outcomes in patients with severe mitral valve disease. However, the impact of CHF on in-hospital outcomes following TMVR or TMVr remains unclear. Methods In this retrospective cohort study, we utilized the United States National Inpatient Sample database from 2016 to 2020. We identified patients who underwent TMVR or TMVr using ICD-10 codes and stratified them based on the presence or absence of CHF diagnosis. We assessed in-hospital complications, length of stay, and cost of care as primary and secondary outcomes. We performed multivariate logistic regression analysis to control for potential confounders. Results Our study included 48,885 patients who underwent TMVR or TMVr, of which 16,132 (33%) had a diagnosis of CHF. The cohort was predominantly male (54%) with a mean age of 76 years. Compared to patients without CHF who underwent TMVR/TMVr, those with CHF had lower rates of in-hospital mortality, valvular complications, cardiogenic shock, vascular complications, bleeding, blood transfusions, respiratory failure, acute kidney injury, and acute myocardial infarction (see Figure 1). Additionally, patients with CHF had a reduced length of stay (coefficient -3.48; p &amp;lt;0.001) and cost of care (coefficient -$58749.37; p &amp;lt;0.001). However, there were no significant differences in rates of pericardial tamponade, intracranial hemorrhage, or ischemic strokes. Conclusions Our findings suggest that patients with chronic heart failure (CHF) who underwent transcatheter mitral valve repair or replacement (TMVr or TMVR) had better in-hospital outcomes compared to those without CHF. This may be due to a protective effect of the chronic disease, where compensatory mechanisms developed by the body may help patients with CHF better tolerate the procedure and have decreased in-hospital complications. These results highlight the importance of further investigating the role of CHF in TMVr/TMVR outcomes and tailoring patient selection for these procedures.

Abstract 16097: Association of Neighborhood Income and Outcomes in Atrial Fibrillation: A Nationwide Retrospective Cohort Analysis

Introduction: The impact of socioeconomic status on atrial fibrillation (AF) outcomes is not well understood. We studied the association between household income and clinical outcomes in AF hospitalizations. Methods: We conducted a retrospective analysis of adult primary AF hospitalizations from the United States National Inpatient Sample (NIS) between 2016 and 2020. Quartile classification of the median household income of the zip code of the patient’s residence provided by NIS was used. Among the four income quartiles, lowest quartile was used as reference category. Weighted multivariable logistic and linear regression, adjusting for multiple patient and hospital-level characteristics (Table 1), were performed. We aimed to study patient characteristics and clinical outcomes in AF based on household income. Results: From lowest to highest income quartile, mean age and proportion of White race increased; proportion of females, Black, and Hispanic race decreased (Table 1). Compared with lowest income residents, highest income residents had lower in-hospital mortality (Odds ratio [OR] 0.78, 95% confidence interval [CI] 0.7, 0.87, P &lt; 0.001), lower disposition to care facility (OR 0.86, 95% CI 0.83-0.9, p &lt; 0.001), lower length of stay (adjusted mean difference -0.26, 95% CI -0.30, -0.22, P &lt; 0.001), higher procedure utilization including catheter and surgical ablation, atrial appendage closure, electrical cardioversion, and higher healthcare costs ($12,124 vs 10,018)(Table 1). Conclusions: We identified significantly higher adverse events and lower procedural/resource utilization in the lower-income residents compared to higher-income residents. Further research is needed to better understand these disparities, their impact on clinical outcomes, and strategies to improve healthcare disparities between SE groups.

Abstract 14654: Contemporary Gender Differences in Clinical Outcomes of Patients With Takotsubo Cardiomyopathy - A United States National Inpatient Sample Database Analysis

Introduction: Takotsubo cardiomyopathy (TCM) is classically more prevalent in females, however whether gender differences exist in clinical outcomes of patients with TCM need further clarification. Given the lower prevalence of TCM in males, limitations of previous research included small sample size and demographic disproportion between groups. The purpose of our study is to analyze gender differences in clinical outcomes of TCM hospitalizations using national inpatient sample (NIS). Methods: We searched the 2020 NIS for TCM hospitalizations using ICD 10 code I51.81. Multivariable logistic regression model adjusted for patient and hospital level confounders was used to compare the clinical outcomes between genders. Results: We identified 41,290 TCM hospitalizations in 2020. Of these 19.9% were males (mean age = 63 years, mean charlson comorbidity index = 3.2) and 80.1% were females (mean age = 68 years, mean charlson comorbidity index = 2.7). Females had a lower risk of inpatient mortality (OR: 0.49, 95% CI 0.41-0.58, p &lt; 0.001), cardiac arrest (OR: 0.58, 95% CI 0.43-0.79, p = 0.001) and cardiogenic shock (OR: 0.67, 95% CI 0.55-0.82, p &lt; 0.001). There was no gender difference in the use of intra-aortic balloon pump (IABP), Impella assist system, or extra-corporeal membrane oxygenation (ECMO) Figure 1. Conclusion: Our findings indicate that despite a higher prevalence of TCM in females, clinical outcomes were worse in males. In our analysis, there was no gender difference in the use of IABP, Impella or ECMO. Future research is needed to better understand clinical predictors of adverse cardiac events in male patients hospitalized with TCM to improve outcomes.

Abstract 13383: Extracorporeal Membrane Oxygenation for COVID-19-associated Acute Respiratory Distress Syndrome: A Nationwide Analysis

Introduction: While extracorporeal membrane oxygenation (ECMO) has been used for patients with COVID-19-associated acute respiratory distress syndrome (ARDS), its benefit in the nationwide setting is unknown. Aim: To evaluate the association between the use of ECMO and outcomes of COVID-19-associated ARDS in the nationwide setting. Methods: Using the United States National Inpatient Sample in 2020, we identified adults hospitalized and mechanically ventilated for COVID-19 with ARDS and divided them into three groups according to the use of ECMO (i.e., no-ECMO, venovenous [VV]-ECMO, and venoarterial [VA]-ECMO). The primary outcome was in-hospital mortality, and the secondary outcomes were the length of hospital stay (LOS) and the total costs during hospitalization. We applied a multivariable logistic regression model for the primary outcome, adjusting for baseline characteristics and underlying comorbidities. Results: Of the total of 72,415 included patients, 68,795, 3,280, and 340 patients received no-, VV-, and VA-ECMO, respectively (Table) . The crude mortality was the highest in the no-ECMO group (59.8%; 41,110/68,795), followed by VA-ECMO (47.1%; 160/340), and VV-ECMO groups (44.8%; 1,470/3,280). LOS was the longest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. Similarly, the total costs during hospitalization were the highest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. After adjusting for the covariates, VV- or VA-ECMO was not associated with lower mortality compared to no-ECMO (adjusted odds ratio [95% confidence interval]: 0.98 [0.82-1.18] and 1.12 [0.62-2.04], respectively). Conclusions: In the nationwide setting, ECMO was not associated with improved mortality in patients with COVID-19-associated ARDS but was associated with longer LOS and higher costs. Future studies exploring the characteristics of suitable candidates for ECMO are warranted.

Abstract 14708: Heart Failure While Homeless: Examining the Relationship Between HF Hospitalizations and Housing Insecurity

Background: The association between housing insecurity and outcomes of hospitalizations for heart failure (HF) has not been previously well-established. Methods: We analyzed HF hospitalizations using the 2020 United States National Inpatient Sample database. Individuals were identified as having housing insecurity by related ICD-10 codes. Other demographic and comorbidity data were identified using corresponding ICD-10 codes. Characteristics of patients hospitalized for HF that were identified as having housing insecurity were compared to those hospitalized for HF who had no housing insecurity. We performed a multivariable risk adjustment for in-hospital mortality based on patient characteristics. Results: Out of 1,003,270 hospitalizations for HF, 16,150 were identified as having housing insecurity (1.6%). The average age of patients with housing insecurity hospitalized for HF was 56, as compared to 71 in the housed population. A higher proportion of patients in the housing-insecure group were Black (35% vs 20.1%) or Hispanic (11.1% vs 7.3%). Patients with housing insecurity were more likely to carry a diagnosis of alcohol use disorder (15.2% vs 3.3%) or substance use disorder (70.2% vs 17.8%), however they were less likely to use tobacco (18.3% vs 28.7%). Patients with housing insecurity were over 4.5 times more likely to have a primary Medicaid payer (52.4% vs 11.3%). Average length of stay did not differ between housing-insecure patients versus those without (5.37 vs 5.51 days). After adjusting for patient characteristics, housing insecurity was predictive of lower in-hospital mortality (OR 0.622, 95% CI 0.403 - 0.960). Conclusions: Significant differences occur between patients hospitalized for HF who also have housing insecurity. These differences are most pronounced for substance use and psychiatric disorders. However, housing insecurity was predictive of lower in-hospital mortality. Admissions for heart failure may provide important opportunities to screen for and address comorbid conditions for patients with housing insecurity, as well as for other vulnerable populations.