Cardiac arrhythmias in patients hospitalized with cardiac amyloidosis were associated with a significantly higher risk of in-patient mortality (10.4% vs 6.5%, HR 1.34) compared to those without.
Observational (n=145,920)
Yes
Does the presence of arrhythmias or ICD implantation impact in-hospital mortality and healthcare utilization in patients with cardiac amyloidosis?
Arrhythmias are highly prevalent in cardiac amyloidosis and are associated with increased in-hospital mortality and resource utilization, whereas ICD implantation is associated with lower in-hospital mortality.
Hazard Ratio: 1.34 (95% CI 1.23–1.46)
Absolute Event Rate: 10.4% vs 6.5%
p-value: p=<0.001
Abstract Background Patients with cardiac amyloidosis (CA) have increased mortality, which can be explained in part by an increased risk of arrhythmias. The burden of arrhythmias in CA, their predictors, and impact on in‐hospital outcomes remains unclear. The role of implantable cardioverter‐defibrillators (ICD) in this population is also uncertain. Methods We queried the National Inpatient Sample (NIS) using ICD‐9‐CM codes 277. 39 and 425. 7 to identify CA. Twelve common arrhythmias were extracted using appropriate, validated ICD‐9‐CM codes. ICD implantation was identified using procedure ICD‐9 codes 37. 94 to 37. 98, 00. 51 and 00. 54. Results There were a total of 145, 920 CA hospitalizations between 1999 and 2014 in the United States and 56, 199 (38. 5%) of them were associated with arrhythmias. The prevalence of arrhythmias remained relatively constant from 41. 5% in 1999 to 40. 2% in 2014. The most common arrhythmia was atrial fibrillation (25. 4%). In‐patient mortality was significantly higher in CA patients with arrhythmias (10. 4% vs 6. 5%, P <. 001). ICD implantation was performed in 1, 381 (0. 94%) patients with CA and analysis revealed an incremental trend in implantation over the study period (0. 48% in 1999 to 0. 65% in 2014). In‐hospital mortality was significantly lower in patients who underwent ICD implantation (3. 7% vs 8%; P =. 0078). CA patients with arrhythmias also had an increased cost of hospitalization and length of stay (65, 046 ± 1, 079 vs 53, 322 ± 687 and 8. 3 ± 0. 1 vs 7. 4 ± 0. 1 days, respectively; P <. 0001). Conclusion Cardiac arrhythmias are common in patients with CA and are associated with worse in‐hospital outcomes, increased length of stay, and cost of hospitalization.
Isath et al. (Thu,) conducted a observational in Cardiac amyloidosis (n=145,920). Arrhythmias vs. No arrhythmias was evaluated on In-patient mortality (HR 1.34, 95% CI 1.23-1.46, p=<0.001). Cardiac arrhythmias in patients hospitalized with cardiac amyloidosis were associated with a significantly higher risk of in-patient mortality (10.4% vs 6.5%, HR 1.34) compared to those without.