Time trends in acute coronary syndrome hospitalizations and outcomes in patients with Systemic Lupus Erythematosus: A US inpatient cohort analysis

Objective SLE is an autoimmune disease linked to higher cardiovascular risks, such as ACS. Limited real-world data exists on ACS outcomes in SLE patients. This study examines trends in ACS hospitalizations among SLE patients (2006–2019) and compares outcomes and healthcare utilization between ACS patients with and without SLE. Methods Utilizing data from the US National Inpatient Sample from 2006 to 2019, ACS hospitalizations were classified by the presence or absence of SLE using ICD-9 and ICD-10 codes. Hospitalization rates, mortality, length of stay, and charges were compared between the two groups. Chi-square and t-tests assessed associations with SLE for categorical and continuous variables, respectively, with p < 0.05 as the significance threshold. Results Of 17,318,554 ACS hospitalizations, 70,882 involved SLE patients, who were more often under 50, female, African American, and had higher rates of antiphospholipid syndrome, chronic and ESRD, and prior thromboembolism. From 2006 to 2019, ACS hospitalization rates fell by 40% in SLE patients—mainly from 2015 to 2019—and by 50% in non-SLE patients. In-hospital mortality was similar (7.0% vs. 6.9%, P=0.52), though SLE patients experienced longer hospital stays (6.2 vs. 5.5 days, P<0.001) and higher charges ($79,909 vs. $74,294, P<0.001). Conclusion SLE patients with ACS require higher healthcare utilization, with longer hospital stays and higher charges. Although ACS hospitalization rates declined for both groups, the decrease was greater in non-SLE patients. These findings underscore the need for continuous targeted cardiovascular risk management strategies in SLE patients to reduce morbidity and healthcare burden.