US National Inpatient Research Articles

Bariatric surgery decreases the number of future hospital admissions for diastolic heart failure in subjects with severe obesity: a retrospective analysis of the US National Inpatient Sample database.

Considerable evidence documents the effectiveness and efficacy of bariatric surgery (BaS) in reducing the prevalence and severity of obesity-related co-morbidities. Diastolic heart failure (DHF) is a condition with considerable morbidity and mortality, yet recalcitrant to medical therapy. Our objectives were to assess whether BaS is associated with a decrease in hospital admissions for DHF and determine its impact upon DHF hospital admissions among patients with hypertension (HTN) and coronary artery disease (CAD). Academic institution. Data on 296 041 BaS cases and 2 004 804 controls with severe obesity were extracted from the US National Inpatient Sample database for the years 2010 to 2015 and compared. Univariate and multivariable analysis were performed to assess the impact of pre-2010 BaS on the rate of hospital admissions for DHF, adjusting for demographics, co-morbidities, and other risk factors associated with cardiovascular disease (CVD). Relative to controls, all baseline CVD risk factors were less common among BaS cases. Nonetheless, even after adjusting for all CVD risk factors, controls exhibited marked increases in the odds of DHF overall (odds ratio = 2.80; 95% confidence interval = 2.52-3.10). Controls with HTN and CAD demonstrated an almost 3-fold increase in odds of DHF admissions. Similarly, controls with no HTN demonstrated a 5-fold increase in odds of admissions for DHF when compared to the surgical group. In this retrospective, case control study of a large, representative national sample of patients with severely obesity, BaS was found to be associated with significantly reduced hospitalizations for DHF when adjusted for baseline CVD risk factors. It also reduced DHF incidence in high-risk patients with HTN and CAD.

Cardiac Shock in Patients Hospitalized for Acute Myocardial Infarction

Introduction: There is a paucity of data on in-hospital outcomes and mortality in individuals with myocardial infarction (MI) complicated by cardiogenic shock (CS). However, this complication greatly affects prognosis amongst other factors and is a fairly common concern. We aim to add to the existing body of knowledge in this regard. Methods and Results: Patients with MI admitted from January 1, 2005, to December 31, 2014, were identified from the US National Inpatient Sample. We reported the crude and adjusted trends of in-hospital mortality among the population and selected subgroups. Among 73,573,571 hospitalizations spanning from January 1, 2005, to December 31, 2014, 1,208,029 (1.65%) were attributed to MI. Of these, the number of hospitalized individuals admitted primarily for myocardial infarction with a secondary diagnosis of CS (MICS) was 60,661 (5.02%), 62% (37,885) of which were men. The prevalence by racial ethnicity was 76.13% (39,282) whites, 7.51% (3873) blacks, and (4239) 8.22% Asians. The mean age of all affected with MICS was 68.6 years (SD=13.2). The mortality outcome of the 60661 affected was 21283, i.e., 35.10% mortality. There has been a steady increase in hospitalizations in individuals with myocardial infarction and a secondary diagnosis of cardiogenic shock from 68 per 100 000 hospitalizations in 2005 to 103 per 100 000 hospitalizations in 2014 (p =0.001), it showed 9% vs. 12.2% increase (p =0.001). Of the people that died from MICS, 76.30% (13,754) were white, and Asians and blacks were 8.38% (1,510) and 7.54% (1,359). However, there was no statistical significance in racial differences as p =0.33. Mortality across the various hospital regions showed no statistical significance, p =0.88. However, the mortality among patients with MICS in the in-hospital setting decreased (from 40.80% (2226/5456) in 2005 to 33.70% (2456/7288) in 2014; p =0.001). The mean length of stay (LOS) trend decreased from 9.14 days (SD=10.6) in 2010 to 8.88 days (SD=10.6) in 2013 (p =0.001). There was, however, an upsurge in total hospital charges (CRG) from $147,727 (SD=153,847) in 2010 to $172,357 (SD=201,168) in 2013 (p =0.001). Weekend or weekday admission showed no significant difference in mortality outcome, 73.01% (44,263) vs. 26.99% (16,363) (p =0.18). The adjusted rate for mortality by month revealed that there was a significant increase in in-hospital mortality in December and January (p =0.005). There was a significant difference among patients with congestive cardiac failure (CCF), p =0.001, but type 2 diabetes (T2DM) did not significantly affect the mortality outcomes of these patients. Conclusions: Hospitalizations attributed to MICS rose significantly from January 2005 to December 2014. Our study delineated a decline in MICS in-hospital mortality during this period. Furthermore, a general increase in mortality during December and January was observed in the studied population.

Real-world management and outcomes of 7 million patients with acute coronary syndrome according to clinical research trial enrolment status: a propensity matched analysis.

We aimed to determine whether clinical outcomes and invasive care of acute coronary syndrome (ACS) patients participating in trials differed from those of non-participants, particularly including those who were trial eligible. We included all hospitalizations with a principal diagnosis of ACS in the US National Inpatient Sample between January 2004 and September 2015, stratified by trial enrolment and eligibility using the International Classification of Diseases, ninth revision. We conducted propensity score matching to investigate the following outcomes: all-cause mortality; major bleeding; stroke; composite of mortality, stroke, and cardiac complications [major adverse cardiovascular and cerebrovascular events (MACCEs)]; coronary angiography (CA); and percutaneous coronary intervention (PCI). A total of 7091179 weighted ACS hospitalizations were analysed, including 19684 (0.3%) trial participants and 7071495 non-participants (3485514 of whom were trial eligible). Trial participants were more likely to receive CA [Δ% 28.73%, 95% confidence interval (CI) 27.22-30.24, P < 0.001] and PCI (Δ% 27.13%, 95% CI 24.86-29.41, P < 0.001), with decreased mortality (Δ% -3.51%, 95% CI -4.72 to -2.31, P < 0.001), MACCEs (Δ% -3.04%, 95% CI -4.55 to -1.53, P < 0.001), and bleeding (Δ% -0.89%, 95% CI -1.59 to -0.19, P = 0.013) compared with non-participants. After accounting for eligibility, trial participants were more likely to undergo CA (Δ% 22.78%, 95% CI 21.58-23.99, P < 0.001) and PCI (Δ% 23.95%, 95% CI 21.77-26.13, P < 0.001), and had no difference in mortality (Δ% -0.21%, 95% CI -0.65 to 0.24, P = 0.362). Among ACS patients, trial enrolment was associated with significantly greater invasive care and lower mortality than among matched non-participants. Trial participants were more likely to be invasively managed even when compared with eligible non-participants, even though there was no difference in mortality.

Abstract 10296: Outcomes of Transcatheter Mitral Valve Repair in Patients with Acute Kidney Injury-A US National Inpatient Sample Analysis

Introduction: Data on outcomes of transcatheter mitral valve repair (TMVR) in patients with acute kidney injury (AKI) remains limited. Hypothesis: AKI is associated with worse outcomes in patients undergoing TMVR Methods: We utilized the United States National Inpatient Sample database from the year 2015 to 2018 to evaluate outcomes of TMVR in AKI. Results: A total of 21,505 weighted hospitalizations were included in the analysis. Of the patients who underwent TMVR 3350 (15.6%) developed acute kidney injury. The mean age of patients undergoing TMVR was higher for patients with AKI compared to patients who did not develop AKI was 77 and 76 years respectively. A logistic regression model adjusted for age, gender and baseline comorbidities was developed for predictors of AKI. On adjusted comparison liver disease (OR 2.4 95% CI, 2-2.9), peripheral vascular disease (1.35, 95% CI 1.2-1.53), congestive heart failure (2.76 95% CI, 2.34-3.26) and history of weight loss (1.92 95% CI 1.64-2.25) were significant predictors of AKI. In-hospital mortality was higher for patients with AKI versus no AKI (10.1% vs. 0.7%, p&lt;0.01). Length of stay (13 vs 3 days) and cost of stay ($80787 vs. $ 44086) was significantly higher for patients with AKI versus those who did not develop AKI. Conclusions: AKI is associated with increased in hospital mortality and increased health care resource utilization in patients undergoing TMVR.

Abstract 12560: The Association of Social Risk Factors With Hypertrophic Cardiomyopathy Treatments and Mortality: US National Inpatient Sample, 2012-2018

Introduction: Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease. In small studies race has been associated with disparities in septal reduction therapy (SRT) but little is known about the association of social risk factors with HCM treatments and outcomes. Methods: A retrospective cohort of admissions for HCM in the National Inpatient Sample from 2012-2018 was identified using ICD-9-CM and ICD-10-CM diagnosis codes. SRT and implantable cardioverter-defibrillator (ICD) procedures were identified using ICD-9-CM and ICD-10-CM procedure codes. Logistic regression controlling for social risk factors, Elixhauser comorbidities, pre-existing ICD, and clustering by hospital-year was used to determine the association of social risk factors with HCM procedures and in-hospital mortality. Results: We identified 60,227 patients with HCM; 45.82% with obstructive HCM (oHCM). Among them, 57.25% were female, 18.65% were Black, 26.75% were in the lowest ZIP income quartile, and 14.89% lived in rural areas. ICD procedures were done on 3.07% of patients with HCM. Septal myectomy and alcohol septal ablation were received by 6.89% and 2.21% of patients with oHCM, respectively. The in-hospital mortality rate was 3.32% for HCM admissions. Compared to White patients, Black patients were less likely to receive septal myectomy (odds ratio [OR] 0.56, 95% confidence interval [0.45-0.70], p&lt;0.001) and more likely to receive ICD procedures (OR 1.17 [1.01-1.36], p=0.03). Patients in the lowest income quartile were less likely to receive septal myectomy (OR 0.81 [0.68-0.98], p=0.03) and ICD procedures (OR 0.83 [0.71-0.98], p=0.02). Rural patients were more likely than urban patients to receive septal myectomy (OR 1.39 [1.17-1.64], p&lt;0.001) and to die during hospitalization (OR 1.38 [1.19-1.59], p&lt;0.001). Female patients were less likely to receive ICD procedures (OR 0.69 [0.62-0.76], p&lt;0.001) but more likely to die during hospitalization (OR 1.19 [1.07-1.31], p&lt;0.001). Conclusions: Among 60,227 patients with HCM, social risk factors were associated with significant disparities in in-hospital mortality and in receiving septal myectomy and ICD treatment. Further research is required to identify and address the sources of these disparities.

Ventricular arrhythmia ablation in the presence of mechanical valve utilization and complications of catheter ablation for ventricular arrhythmia in patients with mechanical prosthetic valves.

Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in recent years. We aimed to investigate the nationwide trends in utilization and procedural complications of CA for VAs in patients with mechanical valve (MV) prosthesis. We drew data from the US National Inpatient Sample database to identify cases of VA ablations, including premature ventricular contraction and ventricular tachycardia, in patients with MVs, between 2003 and 2015. Sociodemographic and clinical data were collected and the incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity-matched cohort of patients without prior valve surgery. The study population included a weighted total of 647 CA cases in patients with prior MVs. The annual number of ablations almost doubled, from 34 ablations on average during the "early years" (2003-2008) to 64 on average during the "late years" (2009-2015) of the study (p = .001). Length of stay at the hospital did not differ significantly between patients with MVs and 649 matched patients without prior MVs (5.4 ± 0.4, 4.7 ± 0.3 days, respectively, p = .12). The data revealed a trend toward a higher incidence of complications (12.6% vs. 7.5% respectively, p = .14) and mortality (3.7% vs. 0.7%, respectively, p = .087) among patients with MVs compared to the matched control group, not reaching statistical significance. The data show increased utilization of VA ablations in patients with MVs and a trend toward a higher incidence of in-hospital mortality and complications compared to the propensity-matched control group without MVs.

The impact of obesity on postoperative outcomes in colorectal cancer patients: a retrospective database study.

Obesity is an independent risk factor for worse outcomes in various surgical settings. Whether obesity is a prognostic factor for postoperative morbidity and mortality of colorectal cancer (CRC) is inconclusive. This study aimed to determine the impact of obesity on short-term postoperative outcomes in CRC patients undergoing laparoscopic surgery. Data of a total of 23,898 CRC patients aged ≥ 20years and undergoing laparoscopic resection were extracted from the US National Inpatient Sample (NIS) database and analyzed. The study endpoints were in-hospital mortality, any postoperative complications, infection/sepsis, acute kidney injury (AKI), deep vein thrombosis (DVT)/pulmonary embolisms (PE), and extended hospital stay. Univariate and multivariate logistic regression analyses were performed to examine the associations between patients' obesity status (morbid obese: BMI > = 40kg/m2; obese: BMI 30-39.9kg/m2) and the study outcomes. In 23,898 CRC patients undergoing laparoscopic resection, the prevalence of obesity prevalence was 11.8%. After adjustment, the results revealed that morbid obesity was significantly associated with increased risk for in-hospital mortality (aOR = 2.06, 95%CI: 1.11-3.83), AKI (aOR = 1.78, 95%CI = 1.34-2.36), DVT/PE (aOR = 2.88, 95%CI = 1.70-4.88), and extended LOS (aOR = 1.21, 95%CI = 1.02-1.43), while non-morbid obesity was significantly associated with more DVT/PE (aOR = 2.12, 95%CI = 1.32-3.41) as compared with non-obesity. In patients with CRC undergoing laparoscopic surgery, morbid obesity is strongly associated with worse postoperative outcomes, including increased in-hospital mortality, postoperative AKI and DVT/PE, and extended LOS. The findings of the present study highlight the importance of obesity status in risk stratification for laparoscopic CRC surgery.

Utilization and complications of catheter ablation for ventricular arrhythmias in patients with mechanical valves

Abstract Background Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in the recent years. Ablation for VAs in patients with mechanical valves (MVs), can be challenging due to the chronic anticoagulation therapy, limitations in accessing the cardiac chambers, the risk for entrapment of mapping or ablation catheters between the leaflets of MVs and more. Purpose To investigate the nationwide trends in utilization and complications of CA for VAs in patients with prior MVs. Methods We drew data from the US National Inpatient Sample database to identify cases of VA ablations, including premature ventricular contraction (PVC) and ventricular tachycardia (VT) ablations, in patients with MVs between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity matched cohort of patients without prior valve surgery. Results The study population included a weighted total of 647 CA cases in patients with prior MVs. The annual number of ablations almost doubled, from 34 ablations on average during the “early years” (2003–2008) to 64 annual ablation procedures on average during the “late years” (2009–2015) of the study (p=0.001). Length of stay at the hospital did not differ significantly between patients with MVs and 649 matched patients without prior MVs (5.4±0.4, 4.7±0.3 days respectively, p=0.12). The incidence of complications was higher among patients with and without MVs (12.6% vs. 7.5% respectively, p=0.14), however, not reaching statistical significance. Moreover, the data revealed a trend toward higher mortality among patients with MVs undergoing CA compared to matched control patients without MVs (3.7% vs. 0.7% respectively, p=0.087). Conclusion The utilization of catheter ablations for ventricular arrhythmias in patients with mechanical valves increased substantially over the years. The data show a trend towards increased incidence of morality and complications in the study population, requiring further investigation in larger population cohort. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Padeh Medical Center Research Fund

Associations between Combined Influenza and Pneumococcal Pneumonia Vaccination and Cardiovascular Outcomes

Background: In 2017, the CDC listed heart disease as the leading cause of death, with pneumonia and influenza being the eighth cause of death. Several studies have suggested the protective effects of influenza vaccination on myocardial infarction (MI). Available evidence supports the use of influenza vaccination in decreasing cardiovascular events, and the Joint Commission considers influenza vaccination a metric of quality care for hospitalized patients. Our specific aim was to evaluate the combined use of pneumococcal pneumonia vaccine (PPV) and influenza vaccine on cardiovascular outcomes and mortality. Methods: A retrospective observational study was conducted using the 2012–2015 US National Inpatient Sample (NIS) database, to compare cardiovascular events in adult patients who did and did not receive vaccination during their hospitalization. ICD-9 codes were used to extract data for specific variables. The outcomes included MI, transient ischemic attacks, cardiac arrest, stroke, heart failure, and death. Adjusted relative risks (RR) were calculated using survey-weighted generalized linear models after adjusting for gender, race, socioeconomic status, diabetes, hypertension, hyperlipidemia, smoking status, prior coronary artery disease, and cerebrovascular disease. The effect of vaccination on in-hospital mortality was assessed in each subgroup of cardiovascular events using RR regressions. Results: This study included 22,634,643 hospitalizations, of which 21,929,592 did not receive immunization. Vaccination solely against influenza was associated with lower MI (RR = 0.84, 95% CI: 0.82–0.87, p < 0.001), TIA (RR = 0.93, 95% CI: 0.9–0.96, p < 0.001), cardiac arrest (RR = 0.36, 95% CI: 0.33–0.39, p < 0.001), stroke (RR = 0.94, 95% CI: 0.91–0.97, p < 0.001), and mortality (RR = 0.38, 95% CI: 0.36–0.4, p < 0.001). Vaccination with PPV alone was associated with MI (RR = 1.13, 95% CI: 1.11–1.16, p < 0.001), TIA (RR = 1.28, 95% CI: 1.26–1.31, p < 0.001), stroke (RR = 1.21, 95% CI: 1.18–1.24, p < 0.001), and lower mortality (RR = 0.47, 95% CI: 0.45–0.49, p < 0.001). Combined PPV and influenza vaccine was associated with lower mortality (2.21% vs. 1.03%, p < 0.001) and lower cardiac arrest (0.61% vs. 0.51%, p < 0.001). In the adjusted analysis, the RR was 0.46 (95% CI: 0.43, 0.49) for mortality in the combined vaccinated cohort. The combined vaccination group also had a significantly reduced risk of mortality among those admitted with MI (RR = 0.46), transient ischemic attacks (RR = 0.58), and stroke (RR = 0.42) compared to the nonvaccinated group. Conclusions: Our study shows a significantly reduced risk of mortality with influenza vaccine and PPV and with combined pneumococcal and influenza vaccination. These data suggest that in-hospital administration of pneumonia and influenza vaccines appears safe and supports the use of combined vaccination during hospitalization due to their cardiovascular benefits.

Epidemiology, Time Trends, and Outcomes of Serious Infections in Patients With Vasculitis: A Nineteen-Year National Study.

To examine the epidemiology, time trends, and outcomes and types of serious infections in people with vasculitis in the US. We identified people with vasculitis who were hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections, or opportunistic infections in the 1998-2016 US National Inpatient Sample. We used adjusted logistic regression to examine the predictors of a hospital stay >3 days, total hospital charges greater than the median, discharge to a non-home setting, and in-hospital mortality. We noted 111,345 serious infections in patients with vasculitis (14% of all vasculitis hospitalizations). Among the patients, the mean age was 67.3 years, the Deyo-Charlson comorbidity index score was ≥2 in 54%, 37% were male, and 67% were White. The serious infection hospitalization rate per 100,000 US National Inpatient Sample claims in 1998-2000 versus 2015-2016 (and rates of increase) in patients with vasculitis was as follows: overall, 12.14 versus 25.15 (2.1-fold); opportunistic infections, 0.78 versus 0.83 (1.1-fold); skin and soft tissue infections, 1.38 versus 2.52 (1.8-fold); UTI, 0.35 versus 1.48 (4.2-fold); pneumonia, 7.10 versus 6.23 (0.9-fold); and sepsis, 2.53 versus 14.10 (5.6-fold). Pneumonia was the most common serious infection in 1998-2000 (58%) versus sepsis in 2015-2016 (56%). Sepsis, older age, Deyo-Charlson comorbidity index score of ≥2, urban hospital, or medium/large hospital (by number of beds) were associated with higher health care utilization and in-hospital mortality rates; Northeast region and Medicare and Medicaid payer type were associated with higher rates of health care utilization. Serious infection hospitalization rates are increasing in patients with vasculitis except among those with pneumonia. Sepsis was the most common serious infection in 2015-2016. Several patient and hospital factors are associated with health care utilization and mortality in serious infection hospitalization in vasculitis.

Association and risk factors of healthcare-associated infection and burden of illness among chemotherapy-induced ulcerative mucositis patients.

ObjectivesTo evaluate the association and risk factors of healthcare-associated infection (HAI) and burden of illness among chemotherapy-induced ulcerative mucositis (UM) patients.MethodsFor this research, US National Inpatient Sample database 2017 was utilized to study UM patients. The association of healthcare-associated infection-related burden of illness among UM patients was assessed on the outcome––length of hospital stays (LOS), total charges, in-hospital mortality, and discharge disposition.ResultIn 2017, there were 11,350 adult (> 18 years of age) UM patients, among them there were 415 (3.5%) HAI. After adjusting for patient and clinical characteristics, UM patients with HAI were most likely to have higher total charges and longer LOS (1.91; 95% CIs: 1.51–2.41; P < 0.001; 1.84; 95% CIs: 1.53–2.21; P < 0.001) than those without HAI. Further, mortality was not significantly different. UM patients with HAI were less likely to have higher burden of illness who were younger, females, those living in non-metropolitan or micropolitan counties, and those with lower co-morbidity score. Additionally, UM patients with HAI were more likely to discharge to skilled nursing facility (SNF), intermediate care facility (ICF), and another type of facility (ATF), (aOR = 2.58 (1.16–5.76), P = 0.02), than they were to discharge to self-care or home care.ConclusionUM patients with HAI were more likely to have higher burden of illness and more likely to discharged to the SNF, ICF, and ATF rather than to home or self-care.Clinical relevanceUM patients when associated with HAI have higher burden of illness; a tailored approach to oral care might prevent HAIs and burden of illness among UM.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00784-021-04106-0.

B-PO05-126 UTILIZATION AND COMPLICATIONS OF CATHETER ABLATION FOR VENTRICULAR ARRHYTHMIA IN PATIENTS WITH MECHANICAL VALVES

Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in the recent years. Ablation for VAs in patients with mechanical valves (MVs), can be technically challenging due to limitations in accessing the left ventricle (LV), the risk for entrapment of mapping or ablation catheters between the leaflets of MVs and other challenges. To investigate the nationwide trends in utilization and complications of CA for VAs in patients with prior MVs. We drew data from the US National Inpatient Sample database to identify cases of VA ablations in patients with MVs between 2003 and 2015. Sociodemographic and clinical data were collected, and incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity matched cohort of patients without prior valve surgery. The study population included a weighted total of 647 CA cases in patients with prior MVs patients. The annual number of ablations almost doubled during the “late years” (2009-2015) compared to the "early years" (2003-2008) of the study (p=0.001). Length of stay at hospital was not different among patients with MVs and 649 matched patients without prior MVs (5.4 ± 0.4, 4.7 ± 0.3 days respectively, p=0.12). The complication rate was not significantly different between patients with and without MVs (12.6% vs. 7.5% respectively, p=0.14). There was a trend toward higher mortality among patients with MVs undergoing CA compared to matched patients without MVs (3.7% vs. 0.7% respectively, p=0.087) which did not reach statistical significance. CA for VAs in patients with prior MVs increased substantially over the years evaluated in this study. The data shows a trend towards increased incidence of complications and morality in the study population, requiring further investigation in larger population cohort.

Impact of cancer diagnosis on causes and outcomes of 5.9 million US patients with cardiovascular admissions

IntroductionThere are limited data on causes of cardiovascular (CV) admissions and associated outcomes among patients with different cancers. MethodsAll CV admissions from the US National Inpatient Sample between October 2015 to December 2017 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios (aOR) of in-hospital mortality in different groups. ResultsFrom 5,936,014 eligible CV admissions, cancer was present in 265,221 (4.5%) hospitalizations. There was significant variation in the admission diagnoses among the different cancers, with hematological malignancies being principally associated with heart failure (HF), lung cancer with atrial fibrillation (AF), and colorectal and prostate cancer with acute myocardial infarction (AMI). Admission with haemorrhagic stroke has the highest associated mortality across cancers (20.0–38.4%). In-hospital mortality was higher in cancer than non-cancer patients across most CV admissions (P < 0.001) with AF having the worst prognosis. Compared to group without any cancer, the greatest aOR of mortality was associated with lung cancer in AMI (aOR 2.32, 95% CI 2.18–2.47), ischemic stroke (aOR 2.21, 95%CI 2.08–2.34), AF (aOR 4.69, 95%CI 4.32–5.10) and HF (aOR 2.07, 95%CI 1.89–2.27). ConclusionsThe most common causes of CV admission to hospital vary in patients with different types of cancer, with AMI being most common in patients with colon cancer, HF in patients with hematological malignancies and AF in patients with lung cancer. Patients with cancer, particularly lung cancer, have greater mortality than non-cancer patients after admissions with a CV cause.

Thrombolysis in acute ischaemic stroke patients with chronic kidney disease.

We aimed to determine whether chronic kidney disease (CKD) is associated with adverse in-hospital outcomes after acute ischaemic stroke (AIS) and whether this association is dependent on thrombolysis administration. 885,537 records representative of 4,283,086 AIS admissions were extracted from the US National Inpatient Sample (2005-2015) and categorized into 3mutually exclusive groups: no CKD, CKD without end-stage renal disease (ESRD) and ESRD. Outcomes (mortality, prolonged hospitalisation >4days and disability on discharge-derived using discharge destination as a proxy) were compared between groups using multivariable logistic regressions. Separate models containing interaction terms with thrombolysis were also computed. The median age (interquartile range) of the cohort was 73 (61-83) years and 47.32% were men. Compared with the no CKD group, both CKD/no ESRD group (odds ratio (99% confidence interval)=1.04 (1.0003-1.09), p=0.009) and the ESRD groups (2.06 (1.90-2.25), p<0.001) had significantly increased odds of in-hospital mortality. Patients with CKD/No ESRD (1.03 (1.02-1.06), p<0.001) and ESRD (1.44 (1.37-1.51), p<0.001) were at higher odds of prolonged hospitalisation. Patients with CKD/No ESRD (1.13 (1.10-1.15), p<0.001) and ESRD (1.34 (1.26-1.41), p<0.001) were also at higher odds of moderate-to-severe disability on discharge. Interaction terms between thrombolysis and the CKD/ESRD groups were not statistically significant (p>0.01) for any outcome. Renal dysfunction was independently associated with worse in-hospital outcomes in the acute phase of AIS. These associations were not influenced by the use of thrombolysis as an emergency treatment for AIS. CKD/ESRD should not represent sole contraindications to thrombolysis for AIS.

Fifteen-Year Trends in Incidence of Cardiogenic Shock Hospitalization and In-Hospital Mortality in the United States.

BackgroundThere is a lack of contemporary data on cardiogenic shock (CS) in‐hospital mortality trends.Methods and ResultsPatients with CS admitted January 1, 2004 to December 31, 2018, were identified from the US National Inpatient Sample. We reported the crude and adjusted trends of in‐hospital mortality among the overall population and selected subgroups. Among a total of 563 949 644 hospitalizations during the period from January 1, 2004, to December 30, 2018, 1 254 358 (0.2%) were attributed to CS. There has been a steady increase in hospitalizations attributed to CS from 122 per 100 000 hospitalizations in 2004 to 408 per 100 000 hospitalizations in 2018 (P trend<0.001). This was associated with a steady decline in the adjusted trends of in‐hospital mortality during the study period in the overall population (from 49% in 2004 to 37% in 2018; P trend<0.001), among patients with acute myocardial infarction CS (from 43% in 2004 to 34% in 2018; P trend<0.001), and among patients with non–acute myocardial infarction CS (from 52% in 2004 to 37% in 2018; P trend<0.001). Consistent trends of reduced mortality were seen among women, men, different racial/ethnic groups, different US regions, and different hospital sizes, regardless of the hospital teaching status.ConclusionsHospitalizations attributed to CS have tripled in the period from January 2004 to December 2018. However, there has been a slow decline in CS in‐hospital mortality during the studied period. Further studies are necessary to determine if the recent adoption of treatment algorithms in treating patients with CS will further impact in‐hospital mortality.

In-Hospital Complications in Pregnant Women With Current or Historical Cancer Diagnoses

ObjectiveTo assess the temporal trends, characteristics and comorbidities, and in-hospital cardiovascular and obstetric complications and outcomes of pregnant women with current or historical cancer diagnosis at the time of admission for delivery. MethodsWe analyzed delivery hospitalizations with or without current or historical cancer between January 1, 2004, and December 31, 2014, from the US National Inpatient Sample database. ResultsWe included 43,132,097 delivery hospitalizations with no cancer, 39,118 with current cancer, and 67,336 with historical diagnosis of cancer. The 5 most common types of current cancer were hematologic, thyroid, cervical, skin, and breast cancer. Women with current and historical cancer were older (29 years and 32 years vs 27 years) and incurred higher hospital costs ($4131 and $4078 vs $3521) compared with women without cancer. Most of the cancer types were associated with preterm birth (hematologic: adjusted odds ratio [aOR], 1.48 [95% CI, 1.35 to 1.62]; cervical: aOR, 1.47 [95% CI, 1.32 to 1.63]; breast: aOR, 1.93 [95% CI, 1.72 to 2.16]). Current hematologic cancer was associated with the highest risk of peripartum cardiomyopathy (aOR, 12.19 [95% CI, 7.75 to 19.19]), all-cause mortality (aOR, 6.50 [95% CI, 2.22 to 19.07]), arrhythmia (aOR, 3.82 [95% CI, 2.04 to 7.15]), and postpartum hemorrhage (aOR, 1.31 [95% CI, 1.11 to 1.54]). Having a current or historical cancer diagnosis did not confer additional risk for stillbirth; however, metastases increased the risk of maternal mortality and preterm birth. ConclusionWomen with a current or historical diagnosis of cancer at delivery have more comorbidities compared with women without cancer. Clinicians should communicate the risks of multisystem complications to these complex patients.

Distribution, management and outcomes of AMI according to principal diagnosis priority during inpatient admission.

In recent years, there has been a growing interest in outcomes of patients with acute myocardial infarction (AMI) using large administrative datasets. The present study was designed to compare the characteristics, management strategies and acute outcomes between patients with primary and secondary AMI diagnoses in a national cohort of patients. All hospitalisations of adults (≥18years) with a discharge diagnosis of AMI in the US National Inpatient Sample from January 2004 to September 2015 were included, stratified by primary or secondary AMI. The International Classification of Diseases, ninth revision and Clinical Classification Software codes were used to identify patient comorbidities, procedures and clinical outcomes. A total of 10864598 weighted AMI hospitalisations were analysed, of which 7186261 (66.1%) were primary AMIs and 3678337 (33.9%) were secondary AMI. Patients with primary AMI diagnoses were younger (median 68 vs 74years, P<.001) and less likely to be female (39.6% vs 48.5%, P<.001). Secondary AMI was associated with lower odds of receipt of coronary angiography (aOR 0.19; 95%CI 0.18-0.19) and percutaneous coronary intervention (0.24; 0.23-0.24). Secondary AMI was associated with increased odds of MACCE (1.73; 1.73-1.74), mortality (1.71; 1.70-1.72), major bleeding (1.64; 1.62-1.65), cardiac complications (1.69; 1.65-1.73) and stroke (1.68; 1.67-1.70) (P<.001 for all). Secondary AMI diagnoses account for one-third of AMI admissions. Patients with secondary AMI are older, less likely to receive invasive care and have worse outcomes than patients with a primary diagnosis code of AMI. Future studies should consider both primary and secondary AMI diagnoses codes in order to accurately inform clinical decision-making and health planning.

Serious Infections in Patients With Gout in the US: ANational Study of Incidence, Time Trends, and Outcomes.

To study the epidemiology of serious infections in patients hospitalized with gout. We identified patients with gout hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), or opportunistic infections (OIs) in a US National Inpatient Sample from 1998 to 2016 and examined factors associated with utilization and mortality. We noted 1,140,085 hospitalizations of patients with serious infections and gout (11% of all hospitalizations of patients with gout; 1998-2000 [8.9%], 2015-2016 [14.5%]). Compared to patients without gout, patients with gout hospitalized with serious infections were older (median age 65 versus 74 years), more of them had a Charlson-Deyo comorbidity index score ≥2 (42% versus 65%), and fewer were female (53% versus 35%) or non-White (40% versus 35%), respectively. The most common infection was pneumonia (52%) in 1998-2000 and sepsis (52%) in 2015-2016. Median hospital charges and hospital stays were higher for patients with sepsis and OIs in 2015-2016 ($41,000-$42,000; 5.1-5.5 days) versus those with UTI, pneumonia, or SSTIs ($15,000-$17,000; 3.0-3.9 days). Compared to patients with sepsis, the multivariable-adjusted odds of health care utilization and in-hospital mortality were significantly lower for patients with UTI, SSTIs, and pneumonia, and non-home discharge or in-hospital mortality were lower in patients with OIs. Among patients hospitalized with infections, older age, Medicaid coverage, a higher Charlson-Deyo comorbidity index score, Black race, and Northeast and nonrural hospital location were associated with significantly higher health care utilization and mortality, while female sex, Medicare insurance, and lower income were associated with higher utilization. Given an increasing rate of serious infections, especially sepsis and pneumonia, in individuals with gout, development of effective interventions targeting factors associated with health care utilization and mortality will improve outcomes and reduce burden.

Effect of HIV infection on pre- and post-liver transplant mortality in patients with organ failure.

Organ failure (OF), a leading cause of death in HIV-positive individuals, is common in patients undergoing liver transplantation (LT). We examined the impact of HIV infection on pre- and post-LT mortalities in cirrhotic patients stratified by the number and type of OFs. We performed a cross-sectional study and a retrospective cohort study using the US National Inpatient Sample (NIS) and the United Network for Organ Sharing (UNOS) registry data, respectively. Patients who had not yet undergone LT from the NIS database (2010-2014) and patients undergoing LT from the UNOS database (2003-2016) were included in the study. Analysis of patients (201348) from the NIS database showed that one [adjusted odds ratio (aOR) 1.531; 95% confidence interval (CI) 1.160-2.023], two (aOR 1.624; 95% CI 1.266-2.083) or three or more OFs (aOR 1.349; 95% CI 1.165-1.562) were associated with higher pre-LT mortality in HIV-infected patients compared with HIV-negative patients with the corresponding number of OFs. In patients without OF, HIV infection was not associated with increased pre-LT mortality. UNOS data for patients undergoing LT (38942) showed that the presence of two or more OFs was associated with increased post-LT 1-year mortality in HIV-infected patients compared with non-HIV-infected patients with the corresponding number of OFs (aOR 2.342; 95% CI 1.576-3.480). However, in patients with no OF or only one OF, HIV infection was not associated with increased post-LT 1-year mortality (aOR 1.372; 95% CI 0.911-2.068). The results of this study emphasize the importance of preventing OF development, and justify LT for HIV-infected patients with no or only one OF.

Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure

ObjectiveThis manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC).MethodsThe US National Inpatient Sample was used to identify...