Rupak Desai1, Upenkumar Patel2, Sandeep Singh3, Rushikkumar Bhuva4, Hee Kong Fong5, Pratyusha Nunna6, Dipen Zalavadia7, Hitanshu Dave8, Sejal Savani9, Rajkumar Doshi10. 1. Department of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA. Electronic address: drrupakdesai@gmail.com. 2. Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA. 3. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 4. Department of Internal Medicine, Canton Medical Education Foundation, Canton, OH, USA. 5. Department of Internal Medicine, University of Missouri-Columbia, Columbia, MO, USA. 6. Clinical Observer, Carle Foundation Hospital, Urbana, IL, USA. 7. Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA. 8. Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA. 9. Public Health, New York University, New York, NY, USA. 10. Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV, USA.
Abstract
BACKGROUND: We aimed to analyze the burden and predictors of arrhythmias and in-hospital mortality in chronic obstructive pulmonary disease (COPD)-related hospitalizations using the nationwide cohort. METHODS: We queried the National Inpatient Sample (NIS) (2010-2014) databases to identify adult COPD hospitalizations with arrhythmia. Categorical and continuous variables were compared using Chi-square and Student's t-test/ANOVA. Predictors of any arrhythmia including AF and in-hospital mortality were evaluated by multivariable analyses. RESULTS: Out of 21,596,342 COPD hospitalizations, 6,480,799 (30%) revealed co-existent arrhythmias including 4,767,401 AF-arrhythmias (22.1%) and 1,713,398 non AF-arrhythmias (7.9%). The AF or non-AF arrhythmia cohort consisted mostly of older (mean age~ 75.8 & 69.1 vs. 67.5 years) white male (53.3% & 51.9% vs. 46.9%) patients compared to those without arrhythmias (p < 0.001). The all-cause mortality (5.7% & 5.2 vs. 2.9%), mean length of stay (LOS) (6.4 & 6.5 vs. 5.3 days), and hospital charges ($52,699.49 & $58,102.39 vs. $41,208.02) were higher with AF and non AF-arrhythmia compared to the non-arrhythmia group (p < 0.001). Comorbidities such as cardiomyopathy (OR 2.11), cardiogenic shock (OR 1.88), valvular diseases (OR 1.60), congestive heart failure (OR 1.48) and pulmonary circulation disorders (OR 1.25) predicted in-hospital arrhythmias. Invasive mechanical ventilation (OR 6.41), cardiogenic shock (OR 5.95), cerebrovascular disease (OR 3.95), septicemia (OR 2.30) and acute myocardial infarction (OR 2.24) predicted higher mortality (p < 0.001) in the COPD-arrhythmia cohort. CONCLUSIONS: About 30% of COPD hospitalizations revealed co-existent arrhythmias (AF 22.1%). All-cause mortality, LOS and hospital charges were significantly higher with arrhythmias. We observed racial and sex-based disparities for arrhythmias and related mortality.
BACKGROUND: We aimed to analyze the burden and predictors of arrhythmias and in-hospital mortality in chronic obstructive pulmonary disease (COPD)-related hospitalizations using the nationwide cohort. METHODS: We queried the National Inpatient Sample (NIS) (2010-2014) databases to identify adult COPD hospitalizations with arrhythmia. Categorical and continuous variables were compared using Chi-square and Student's t-test/ANOVA. Predictors of any arrhythmia including AF and in-hospital mortality were evaluated by multivariable analyses. RESULTS: Out of 21,596,342 COPD hospitalizations, 6,480,799 (30%) revealed co-existent arrhythmias including 4,767,401 AF-arrhythmias (22.1%) and 1,713,398 non AF-arrhythmias (7.9%). The AF or non-AF arrhythmia cohort consisted mostly of older (mean age~ 75.8 & 69.1 vs. 67.5 years) white male (53.3% & 51.9% vs. 46.9%) patients compared to those without arrhythmias (p < 0.001). The all-cause mortality (5.7% & 5.2 vs. 2.9%), mean length of stay (LOS) (6.4 & 6.5 vs. 5.3 days), and hospital charges ($52,699.49 & $58,102.39 vs. $41,208.02) were higher with AF and non AF-arrhythmia compared to the non-arrhythmia group (p < 0.001). Comorbidities such as cardiomyopathy (OR 2.11), cardiogenic shock (OR 1.88), valvular diseases (OR 1.60), congestive heart failure (OR 1.48) and pulmonary circulation disorders (OR 1.25) predicted in-hospital arrhythmias. Invasive mechanical ventilation (OR 6.41), cardiogenic shock (OR 5.95), cerebrovascular disease (OR 3.95), septicemia (OR 2.30) and acute myocardial infarction (OR 2.24) predicted higher mortality (p < 0.001) in the COPD-arrhythmia cohort. CONCLUSIONS: About 30% of COPD hospitalizations revealed co-existent arrhythmias (AF 22.1%). All-cause mortality, LOS and hospital charges were significantly higher with arrhythmias. We observed racial and sex-based disparities for arrhythmias and related mortality.
Authors: Rupak Desai; Samarthkumar Thakkar; Hee Kong Fong; Yash Varma; Mir Z Ali Khan; Vikram B Itare; Jilmil S Raina; Sejal Savani; Nanush Damarlapally; Rajkumar P Doshi; Kishorbhai Gangani; Kranthi Sitammagari Journal: Cureus Date: 2019-08-14