Iron-deficiency anemia in hospitalized AMI patients was associated with increased odds of acute kidney injury (aOR 1.51; 95% CI 1.44-1.58; P<0.001), longer length of stay, and higher charges.
Cohort (n=1,894,085)
Yes
Does iron-deficiency anemia worsen in-hospital outcomes and resource use in patients hospitalized with acute myocardial infarction?
In patients hospitalized with AMI, iron-deficiency anemia is associated with greater morbidity, longer hospital stays, and higher costs, highlighting it as a marker of vulnerability.
Effect estimate: aOR 1.51 (95% CI 1.44-1.58)
p-value: p=<0.001
Abstract Rationale Iron-deficiency anemia (IDA) is common in cardiovascular disease and may worsen ischemia and recovery after acute myocardial infarction (AMI). Its population-level association with inpatient complications and resource use in contemporary U. S. care remains unclear. Methods We conducted a retrospective study of adult AMI hospitalizations in the 2018-2020 National Inpatient Sample. Hospitalizations stratified by the presence of IDA were identified using ICD-10 codes. Multivariable, survey-weighted logistic and linear regressions adjusted for demographics, comorbidities (Charlson index), payer, and hospital characteristics were used to estimate adjusted odds ratios (aOR, 95% CI) and β coefficients (95% CI). Outcomes included in-hospital mortality, acute kidney injury (AKI), cardiogenic shock, coronary artery bypass grafting (CABG), any complication of AMI, length of stay (LOS), and inflation-adjusted total charges. Results Of 1, 894, 085 AMI hospitalizations, 59, 470 (3. 1%) had IDA. IDA patients were older (70±13 vs 67±13 years), more often female (51% vs 37%), more frequently Black (17% vs 11%), had a higher comorbidity burden (Charlson 4. 38±2. 19 vs 3. 14±2. 01; all P 0. 001), and were more often Medicare-insured (69% vs 56%). After adjustment, IDA was associated with longer LOS (β, 1. 3 days, 95% CI 1. 2-1. 5; P 0. 001) and higher charges (β, +9, 681, 95% CI 6, 604-12, 758; P 0. 001). IDA increased the odds of AKI (aOR 1. 51, 95% CI 1. 44-1. 58; P 0. 001) and CABG (aOR 1. 13, 95% CI 1. 05-1. 22; P = 0. 001), but was not associated with cardiogenic shock (aOR 0. 94, 95% CI 0. 87-1. 01; P = 0. 10). For in-hospital mortality, the model showed lower odds (aOR 0. 73, 95% CI 0. 66-0. 80; P 0. 001) ; however, given potential collider bias and overadjustment, this finding is interpreted cautiously. Conclusions In a nationally representative AMI cohort, IDA was associated with greater morbidity and resource use—notably higher AKI risk, approximately 1. 3 additional hospital days, and ∼9, 700 higher charges—without increased cardiogenic shock and with a cautiously interpreted lower mortality. These findings suggest IDA may function as a clinical flag for vulnerability to nonfatal complications during AMI care. Early recognition with renal-protective strategies and proactive discharge planning could improve outcomes and resource utilization. Future work should validate coded IDA against laboratory phenotypes and evaluate iron-targeted interventions in pragmatic trials. This abstract is funded by: None
Afzaal et al. (Fri,) conducted a cohort in Acute Myocardial Infarction (n=1,894,085). Iron-deficiency anemia vs. No iron-deficiency anemia was evaluated on Acute kidney injury (AKI) (aOR 1.51, 95% CI 1.44-1.58, p=<0.001). Iron-deficiency anemia in hospitalized AMI patients was associated with increased odds of acute kidney injury (aOR 1.51; 95% CI 1.44-1.58; P<0.001), longer length of stay, and higher charges.