Exploring the interplay of myeloma and acute decompensated heart failure: Mortality and comorbidity insights

Abstract Background: Acute decompensated heart failure (ADHF) is a major driver of hospitalization and mortality, with outcomes potentially worsened by hematologic malignancies such as multiple myeloma (MM), plasma cell leukemia, extramedullary plasmacytoma, and solitary plasmacytoma. MM is associated with heart failure through multifactorial mechanisms, including disease-related factors like amyloid deposition, hyperviscosity, and renal dysfunction, as well as treatment-related cardiotoxicity and high output heart failure. MM patients, typically older with pre-existing cardiovascular comorbidities, face increased heart failure risk via these pathways. This study uses the National Inpatient Sample (NIS) to assess the impact of these hematologic malignancies on in-hospital mortality and clinical outcomes in ADHF patients. Methods: Using NIS data from 2018 to 2022, we identified 6, 074, 232 ADHF hospitalizations which were stratified by hematologic malignancies status: multiple myeloma, plasma cell leukemia, extramedullary plasmacytoma, and solitary plasmacytoma. Survey-weighted logistic regression models estimated crude and adjusted odds ratios (OR) for in-hospital mortality, adjusting for age, sex, race, Charlson Comorbidity Index, income quartile, hospital size, region, payer, and teaching status. Secondary outcomes included length of stay (LOS), total hospital charges, transfusion requirements, and comorbidity prevalence. Results: Of 6, 074, 232 ADHF hospitalizations, 28, 710 had MM, 120 had plasma cell leukemia, 45 had extramedullary plasmacytoma, 255 had solitary plasmacytoma, and 29, 564 had any myeloma-related diagnosis. ADHF patients with MM had a higher mortality rate (4. 37%, 95% CI: 3. 87–4. 94%; 1, 255 deaths) than those without these malignancies (2. 73%, 95% CI: 2. 70–2. 77%; 165, 270 deaths, p 0. 0001). Plasma cell leukemia and solitary plasmacytoma had mortality rates of 8. 33% and 2. 22% (non-significant), respectively, while all 45 extramedullary plasmacytoma cases died. The crude OR for mortality in the MM group was 1. 63 (95% CI: 1. 43–1. 85, p 0. 0000), with an adjusted OR of 1. 26 (95% CI: 1. 11–1. 44, p = 0. 001). The AnyMyelomaDiagnosis group had an adjusted OR of 1. 62 (95% CI: 1. 43–1. 84, p 0. 0000). MM patients were older (74. 18 vs. 70. 85 years, p 0. 001) had higher rates of chronic kidney disease stage 3 (53. 29% vs. 40. 40%), heart failure with preserved ejection fraction (HFpEF, 47. 54% vs. 40. 93%), and transfusion needs (8. 80% vs. 3. 42%), with a higher proportion of Black patients (29. 4% vs. 21. 7%, p 0. 001). They had longer LOS (6. 40 vs. 5. 64 days) and higher charges (70, 605 vs. 63, 438). Classic cardiac risk factors were less prevalent in MM patients, including coronary artery disease (43. 47% vs. 50. 89%), hypertension (1. 24% vs. 1. 32%), smoking (34. 88% vs. 42. 81%), and hyperlipidemia (53. 47% vs. 56. 81%). Conclusion: MM significantly elevates in-hospital mortality in ADHF patients, with adjusted odds 26% higher than in those without MM. MM patients are more likely to have chronic kidney disease (53. 29% vs. 40. 40%) and require transfusions (8. 80% vs. 3. 42%) due to their hematologic malignancy, reflecting the impact of plasma cell dyscrasias on anemia and renal dysfunction. Conversely, they are less likely to have classic cardiac risk factors such as coronary artery disease (43. 47% vs. 50. 89%), hypertension (1. 24% vs. 1. 32%), smoking (34. 88% vs. 42. 81%), and hyperlipidemia (53. 47% vs. 56. 81%), suggesting a distinct pathophysiological profile driven by MM-related mechanisms like amyloidosis and treatment-related cardiotoxicity. Small sample sizes for rare malignancies limited statistical power. Future studies should investigate paraprotein-mediated cardiac effects and optimize multidisciplinary strategies to improve outcomes in this high-risk population.