Dataset Information

Sickle cell disease-associated arrhythmias and in-hospital outcomes: Insights from the National Inpatient Sample.

ABSTRACT:

Background

The frequency and temporal trend in the prevalence of arrhythmias and associated in-hospital outcomes in patients with sickle cell disease (SCD) have never been quantified.

Methods

Our study cohort of SCD patients and sub-types of arrhythmias were derived from the 2010-2014 National Inpatient Sample using relevant diagnostic codes. The frequency and trends of arrhythmia and odds of inpatient mortality were measured.

Results

A total of 891 450 hospitalized SCD patients were identified, of which, 55 616 (6.2%) patients experienced arrhythmias. The SCD cohort with arrhythmia demonstrated higher all-cause mortality (2.7% vs 0.4%; adjusted OR 2.53, 95% CI 2.15-2.97, P < .001), prolonged hospital stays (6.9 vs 5.0 days) and higher hospital charges ($53 871 vs $30 905) relative to those without arrhythmias (P < .001).The frequency of supraventricular arrhythmia (AFib, SVT, and AF) and ventricular arrhythmia (VFib and VT) were 1893 and 362 per 100 000 SCD-related admissions, respectively. Unspecified arrhythmias (4126) were seen most frequently followed by AFib (1622) per 100 000 SCD-related admissions. From 2010 to 2014, the frequency of any arrhythmias and atrial fibrillation in hospitalized SCD patients relatively increased by 29.6% and 38.5%, respectively. There was nearly a twofold (2.4% in 2010 to 5.0% in 2014) increase in the frequency of arrhythmia among patients aged <18 years. The frequency of arrhythmias in hospitalized male and female SCD patients relatively increased by 28.8% and 31.4%, respectively (P _trend < .001).

Conclusions

The frequency of arrhythmias among SCD patients is on the rise with worse hospitalization outcomes, including higher in-hospital mortality and higher resource utilization as compared to those without arrhythmias.

SUBMITTER: Patel U

PROVIDER: S-EPMC7733582 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Sickle cell disease-associated arrhythmias and in-hospital outcomes: Insights from the National Inpatient Sample.

Patel Upenkumar U Desai Rupak R Hanna Bishoy B Patel Dhruval D Akbar Shahzad S Zubair Mohammed M Kumar Gautam G Sachdeva Rajesh R

Journal of arrhythmia 20200808 6

<h4>Background</h4>The frequency and temporal trend in the prevalence of arrhythmias and associated in-hospital outcomes in patients with sickle cell disease (SCD) have never been quantified.<h4>Methods</h4>Our study cohort of SCD patients and sub-types of arrhythmias were derived from the 2010-2014 National Inpatient Sample using relevant diagnostic codes. The frequency and trends of arrhythmia and odds of inpatient mortality were measured.<h4>Results</h4>A total of 891 450 hospitalized SCD pat ...[more]

PMID: 33335626

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Project description:ImportancePregnancy outcomes are historically poor among people with sickle cell disease (SCD) in the US, most of whom have Black race. Whether outcomes have improved is unknown.ObjectiveTo tabulate adverse pregnancy outcomes among patients with SCD, comparing outcomes of deliveries among Black people with SCD with those of Black people without SCD and a control non-Black population, and to measure the association of racial disparities with adverse outcomes in SCD pregnancies.Design, setting, and participantsThis cross-sectional study was a secondary analysis involving data from National Inpatient Sample, a nationally representative sample of 20% of acute hospital admissions in the US, between 2012 and 2018. The data set included all admissions with codes for delivery of a pregnancy among people aged 11 to 55 years. Data were analyzed from September 2021 to August 2022.ExposuresSCD, racial disparities.Main outcomes and measuresSevere maternal morbidity (SMM) as measured by the US Centers for Disease Control and Prevention's index alongside other outcomes; multiple logistic regression was used to compare the odds for adverse pregnancy outcomes.ResultsThe sample included 5 401 899 deliveries, including 3901 deliveries among people with SCD and 742 164 deliveries among people with Black race. Compared with the non-Black control group, patients with SCD and Black patients were younger (mean [SD] age: SCD, 27.2 [5.9] years; Black, 27.1 [6.1] years vs 28.7 [5.9] years) and more likely to have public insurance (SCD, 2609 deliveries [67.3%]; Black, 496 828 deliveries [65.4%] vs 1 880 198 deliveries [40.8%]). The maternal mortality rate in deliveries among people with SCD was 26 times greater than in the non-Black control group and more than 10 times greater than among Black pregnant people without SCD (Per 10 000 deliveries: SCD 13.3; 95% CI, 5.7-31.2; Black race, 1.2; 95% CI, 1.0-1.5; non-Black control 0.5; 95% CI, 0.5-0.6). Compared with the control group, SCD deliveries had higher odds of SMM (adjusted odds ratio [aOR], 7.22; 95% CI, 6.25-8.34; P < .001), especially cerebrovascular events (aOR, 22.00; 95% CI, 15.25-31.72; P < .001) and thromboembolism (aOR, 17.34; 95% CI, 11.55-26.03; P < .001). Racial disparities explained a median (IQR) 28.9% (21.2%-33.1%) of the increased risk in deliveries to people with SCD and between 40% and 50% of the increased risk for acute kidney failure (excess risk [ER], 56.9%; 95% CI, 54.3%-59.3%), intrauterine fetal demise (ER, 47.8%; 95% CI, 46.6%-49.1%), and eclampsia (ER, 42.1%; 95% CI, 37.9%-46.1%).Conclusions and relevanceIn this large cross-sectional study of pregnancy outcomes in people with SCD, the risk for SMM was higher compared with deliveries among people without SCD, especially for thrombotic events, organ failure, and death. Racial disparities were associated with adverse outcomes. Our findings compel scientific, clinical, and political effort to improve outcomes for pregnant people with SCD.

Project description:Abstract Background Research has shown mixed results when comparing in‐hospital complications following atrial fibrillation ablation in women compared to men. Objectives To better quantify sex differences and in‐hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes. Methods We queried the NIS database from 2016 to 2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in‐hospital mortality, and complications of women compared to men. Results Admissions for atrial fibrillation were more common in females than males (849 050 vs. 815 665; p < .001). However, females were less likely to receive ablation (1.65% vs. 2.71%, OR: 0.60; 95% confidence interval: 0.57–0.64, p < .001), which persisted after adjusting for cardiomyopathy (adjusted OR: 0.61; 95% confidence interval: 0.58–0.65, p < .001). The primary outcome of in‐hospital mortality was not statistically different in univariate analysis (0.39% vs. 0.36%, OR: 1.09, 95% CI: 0.44–2.72, p = .84), finding that did not change when adjusted for comorbidities (adjusted OR: 0.94, 95% CI: 0.36–2.49). The complication rate in hospitalized patients following ablation was 8.08%. The total unadjusted complication rate was higher for females than males (9.58% vs. 7.09%, p = .001); however, it was not significant when adjusted for risks (adjusted OR: 1.23, 95% CI: 0.99–1.53, p = .06). Conclusion Female sex is not associated with increased complications or death in a real‐world study of catheter ablation when results are adjusted for risks. However, females admitted with atrial fibrillation receive ablation less often than males during hospital admission. Women make up a larger group of admitted atrial fibrillation patients than males. However, women with atrial fibrillation had a 39% lower likelihood of receiving catheter ablation in the hospital when compared to men. In‐hospital mortality was not statistically different between women and men in univariate and multivariate analyses. The total unadjusted complication rate was higher for women than men; however, it was insignificant when adjusted for risks. When controlled for risk factors, female sex was not associated with increased complications or in‐hospital death in a real‐world study.

Dataset Information

Sickle cell disease-associated arrhythmias and in-hospital outcomes: Insights from the National Inpatient Sample.

Background

Methods

Results

Conclusions

Publications

Sickle cell disease-associated arrhythmias and in-hospital outcomes: Insights from the National Inpatient Sample.

Similar Datasets

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