What Predicts In-Hospital Mortality Among Patients With Cardiac Arrhythmias and Acute Ischemic Disorders of the Intestine: Insights from the Nationwide Inpatient Sample

Introduction: Acute ischemic disorders of the intestine are the result of a sudden reduction or occlusion in blood flow through the mesenteric arteries. Atrial fibrillation and other cardiac arrhythmias are often involved in the development of acute ischemic disorders of the intestine. This study aims to determine the in-hospital outcomes of patients diagnosed with acute ischemic disorders of the intestine and cardiac arrhythmias. Methods: We utilized the National Inpatient Sample database to identify adult patients with acute ischemic disorders of the intestine, using International Classification of Diseases 10th Edition (ICD-10-CM) codes from 2016 to 2018. We defined cardiac arrhythmias as supraventricular tachycardia, atrial fibrillation, and atrial flutter. The primary outcome evaluated was in-hospital mortality; secondary outcomes included the cost of hospitalization and length of stay. We performed multivariate logistic regression analysis to identify associations for in-hospital mortality. Statistical analysis was carried out using JMP Pro, version 17.0.0 (SAS Institute Inc., Cary NC). Results: We identified 27,764 hospitalizations with acute ischemic disorders of the intestine and of these patients, 6,974 (25.12%) had cardiac arrhythmias. Median age was 69 years (IQR 58-79 years), 59.02% female, and 76.44% Caucasian. The in-hospital mortality was 19.57% the median cost for hospitalization was $67,202 (IQR $31,142-$154,705), and the median length of stay was 6 days (IQR 3-12 days). The presence of cardiac arrhythmias had a higher in-hospital mortality rate at 29.31% compared with 16.30% for those without cardiac arrhythmias, P-value < 0.0001. Multiple logistic regression analysis revealed that presence of cardiac arrhythmias was a significant predictor of mortality (OR 1.66, 95% CI 1.55-1.77, P < 0.0001) along with acute coronary syndrome (OR 2.62, 95% CI 2.33-2.94, P < 0.0001), stroke (OR 2.39, 95% CI 1.97-2.90, < 0.0001), acute kidney injury (OR 3.98, 95% CI 3.73-4.25, P < 0.0001), and COPD (OR 1.31, 95% CI 1.21-1.42, P = 0.0105) were significant predictors of mortality. Conclusion: Our analysis demonstrates that the presence of cardiac arrhythmias is a significant predictor of mortality in acute ischemic disorders and other complications, such as acute kidney injury, play a significant role in in-hospital mortality. Therefore, recognition of these complications and aggressive early management can reduce in-hospital mortality.