A58-07 Prevalence and Impact of Iron Deficiency Anemia in Hospitalized Patients With Acute Myocardial Infarction: A National Inpatient Sample Analysis, 2018-2020

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