Key result
Coexisting pulmonary hypertension in patients hospitalized for sick sinus syndrome was associated with a significantly increased risk of in-hospital mortality (aOR 1.68).
Why the study?
Pulmonary hypertension can cause right atrial remodeling predisposing to sinus node dysfunction, but its impact on clinical outcomes in sick sinus syndrome hospitalizations remained unestimated.
Does coexisting pulmonary hypertension increase inpatient mortality and adverse outcomes in patients hospitalized for sick sinus syndrome?
Cohort (n=181,230)
Yes
Does coexisting pulmonary hypertension increase inpatient mortality and adverse outcomes in patients hospitalized for sick sinus syndrome?
Answers are grounded in this paper and cite their sources.
In patients hospitalized for sick sinus syndrome, the presence of pulmonary hypertension is associated with significantly worse clinical outcomes, including increased mortality, acute kidney injury, and cardiogenic shock.
Sick sinus syndrome (SSS) is a condition of the sinoatrial node that arises from a constellation of aberrant rhythms, resulting in reduced pacemaker activity and impulse transmission. According to the World Health Organization, pulmonary hypertension (PH) is defined by a mean pulmonary arterial pressure of >25 mmHg at rest, measured during right heart catheterization. It can result in right atrial remodeling, which may predispose the patient to sinus node dysfunction. This study sought to estimate the impact of PH on clinical outcomes of hospitalizations with SSS. The U.S. National Inpatient Sample database from 2016-2019 was searched for hospitalized adult patients with SSS as a principal diagnosis with and without PH as a secondary diagnosis using the International Classification of Diseases, Tenth Revision, codes. The primary outcome was inpatient mortality. The secondary outcomes were acute kidney injury (AKI), cardiogenic shock (CS), cardiac arrest, rates of pacemaker insertion, total hospital charges (THCs), and length of stay (LOS). Multivariate regression analysis was used to adjust for confounders. A total of 181,230 patients were admitted for SSS; 8.3% (14,990) had underlying PH. Compared to patients without PH, patients admitted with coexisting PH had a statistically significant increase in mortality (95% confidence interval, 1.21-2.32; P = .002), AKI (P < .001), CS (P = .004), THC (P = .037), and LOS (P < .001). In conclusion, patients admitted primarily for SSS with coexisting PH had a statistically significant increase in mortality, AKI, CS, THC, and LOS. Additional studies geared at identifying and addressing the underlying etiologies for PH in this population may be beneficial in the management of this patient group.
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Orji et al. (2023) conducted a cohort in Sick Sinus Syndrome (n=181,230). Pulmonary hypertension vs. No pulmonary hypertension was evaluated on Inpatient mortality (aOR 1.68, 95% CI 1.21-2.32, p=0.002). Coexisting pulmonary hypertension in patients hospitalized for sick sinus syndrome was associated with a significantly increased risk of in-hospital mortality (aOR 1.68).
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