In-hospital Outcomes Of Patients With Systemic Sclerosis Admitted For Heart Failure: An Analysis Of The National Inpatient Sample

Introduction Cardiac involvement in systemic sclerosis (SSc) can manifest in a variety of ways, from pericardial disease, conduction abnormalities, myocardial ischemia, to overt heart failure (HF). HF in SSc patients is due to an interplay of microvascular disease and myocardial inflammation, resulting in fibrosis and myocardial dysfunction. Large scale data analyzing the relationship between systemic sclerosis and heart failure is lacking. We aimed to analyze the in-hospital outcomes and characteristics of patients admitted with heart failure with co-morbid SSc, and compare them to those without SSc, using the National Inpatient Sample (NIS) from 2016 to 2019. Hypothesis Given the significant difference in the pathophysiology of SSc-associated HF, we hypothesized that these patients would have different baseline clinical characteristics, as well as worse cardiovascular outcomes, compared to patients without SSc. Methods Data from 2016 to 2019 were extracted from the NIS database. A search was performed using International Classification of Diseases, Tenth Revision codes (ICD-10) for heart failure and systemic sclerosis. Patients hospitalized with a primary diagnosis of heart failure along with secondary diagnoses of systemic sclerosis were identified. Baseline demographics and characteristics were analyzed. Multivariate logistic and linear regression analysis was used to adjust for confounders. Outcomes of mortality, length of stay (LOS), and costs were compared between the two groups. Results We identified 4,820,214 hospitalizations with a primary diagnosis of heart failure. 8,180 (0.17 %) were noted to have SSc. 82.3% of patients with HF and comorbid SSc were female (vs 47.8% in HF without SSc). These patients were also noted to have lower rates of coronary artery disease (35.9% vs 50.6%), hyperlipidemia (39.4% vs 52.8%), diabetes (23.2% vs 49.0%), and obesity (13.3% vs 25.0%). They had higher rates of concurrent interstitial lung disease (12.1% vs 0.8%), pulmonary hypertension (35% vs 12.6%) and oxygen dependence (22.2% vs 10.8%). Multivariate logistic regression analysis of the two groups (HF with and without SSc) showed statistically significant higher odds of in-hospital mortality in the HF and SSc group (OR 1.92, p<0.001, CI: 1.52-2.43). No clinically significant difference in LOS was noted between the two groups (HF and SSc: 6.43 vs 5.43). Mean hospitalization charges were higher in the SSc group (HF and SSc: $63,012 vs $54,639). Conclusions In patients hospitalized for HF, those with SSc have 92% higher odds of in-hospital mortality than those without SSc. Patients with HF and SSc are also more likely to be younger, female, and have comorbid interstitial lung disease, pulmonary hypertension and be oxygen dependent at baseline. Additionally, these patients are less likely to have traditional cardiovascular risk factors associated with HF such as CAD, hyperlipidemia, diabetes, and obesity. Cardiac involvement in systemic sclerosis (SSc) can manifest in a variety of ways, from pericardial disease, conduction abnormalities, myocardial ischemia, to overt heart failure (HF). HF in SSc patients is due to an interplay of microvascular disease and myocardial inflammation, resulting in fibrosis and myocardial dysfunction. Large scale data analyzing the relationship between systemic sclerosis and heart failure is lacking. We aimed to analyze the in-hospital outcomes and characteristics of patients admitted with heart failure with co-morbid SSc, and compare them to those without SSc, using the National Inpatient Sample (NIS) from 2016 to 2019. Given the significant difference in the pathophysiology of SSc-associated HF, we hypothesized that these patients would have different baseline clinical characteristics, as well as worse cardiovascular outcomes, compared to patients without SSc. Data from 2016 to 2019 were extracted from the NIS database. A search was performed using International Classification of Diseases, Tenth Revision codes (ICD-10) for heart failure and systemic sclerosis. Patients hospitalized with a primary diagnosis of heart failure along with secondary diagnoses of systemic sclerosis were identified. Baseline demographics and characteristics were analyzed. Multivariate logistic and linear regression analysis was used to adjust for confounders. Outcomes of mortality, length of stay (LOS), and costs were compared between the two groups. We identified 4,820,214 hospitalizations with a primary diagnosis of heart failure. 8,180 (0.17 %) were noted to have SSc. 82.3% of patients with HF and comorbid SSc were female (vs 47.8% in HF without SSc). These patients were also noted to have lower rates of coronary artery disease (35.9% vs 50.6%), hyperlipidemia (39.4% vs 52.8%), diabetes (23.2% vs 49.0%), and obesity (13.3% vs 25.0%). They had higher rates of concurrent interstitial lung disease (12.1% vs 0.8%), pulmonary hypertension (35% vs 12.6%) and oxygen dependence (22.2% vs 10.8%). Multivariate logistic regression analysis of the two groups (HF with and without SSc) showed statistically significant higher odds of in-hospital mortality in the HF and SSc group (OR 1.92, p<0.001, CI: 1.52-2.43). No clinically significant difference in LOS was noted between the two groups (HF and SSc: 6.43 vs 5.43). Mean hospitalization charges were higher in the SSc group (HF and SSc: $63,012 vs $54,639). In patients hospitalized for HF, those with SSc have 92% higher odds of in-hospital mortality than those without SSc. Patients with HF and SSc are also more likely to be younger, female, and have comorbid interstitial lung disease, pulmonary hypertension and be oxygen dependent at baseline. Additionally, these patients are less likely to have traditional cardiovascular risk factors associated with HF such as CAD, hyperlipidemia, diabetes, and obesity.