In-hospital mortality elevated in cystic fibrosis cardiac hospitalizations

Key takeaways:

• Cardiac cause hospitalizations included those for atrial fibrillation, heart failure or myocardial infarction.
• The cardiac vs. noncardiac cause group also had a greater discharge to nursing facility rate.

BOSTON — Hospitalization for a cardiac cause vs. a noncardiac cause in patients with cystic fibrosis yielded elevated in-hospital mortality, according to a presentation at the CHEST Annual Meeting.

“Ever since the introduction of newer therapeutic modalities, especially [cystic fibrosis transmembrane conductance regulator] gene modulators, we’ve noticed that life expectancy has gone up significantly,” Adnan Bhat, MD, assistant professor of hospital medicine at University of Florida, said during his presentation.

“As life expectancy increases, now we begin to see these patients have a lot of chronic conditions, so we started looking at the cardiovascular disease aspect,” Bhat said.

Using 2016 to 2021 data from the National Inpatient Sample database, Bhat and colleagues evaluated 83,250 hospitalizations among patients with cystic fibrosis to find out how those hospitalized for a cardiac cause — atrial fibrillation, heart failure or myocardial infarction — differ from those hospitalized for a noncardiac cause.

Hospitalization for one of the three outlined cardiac causes appeared in less than 1% (0.5%; n = 415) of the total population. Of the 415 cardiac cause hospitalizations, atrial fibrillation was behind 170 hospitalizations, myocardial infarction was behind 150 hospitalizations and heart failure was behind 95 hospitalizations.

Between the set of patients hospitalized for a cardiac cause vs. a noncardiac cause (n = 82,835), researchers observed a significant difference in mean age (59.5 years vs. 34.5 years; P < .001).

Notably, hyperlipidemia, chronic kidney disease, obesity and family history of coronary artery disease were more prevalent in the cardiac cause group, according to the abstract.

Among those hospitalized for a cardiac cause, 5% had an in-hospital death, whereas 2% of those hospitalized for a noncardiac cause had this outcome (P = .044).

In univariate logistic regression analysis and multivariable logistic regression analysis adjusted for age, sex and race, Bhat said in-hospital mortality odds did not significantly differ between the two groups.

“I believe that we don’t have enough number of cases yet, so we couldn’t get it,” Bhat said during the presentation.

A greater proportion of patients in the cardiac cause vs. noncardiac cause group had been discharged to a nursing facility (8% vs. 4%; P = .022). In slight contrast to the in-hospital mortality odds, the odds for discharge to a nursing facility did significantly differ between the two groups but only in univariate analysis (OR = 2.43; 95% CI, 1.11-5.32).

When assessing mortality in each of the three cardiac hospitalizations, those hospitalized for heart failure had the largest proportion of patients who died at 11%, and this was significantly higher than the 2% of patients hospitalized for a noncardiac cause who died (P = .005).

Bhat said that the insufficient number of mortality outcomes among those hospitalized for heart failure meant that they could not conduct a regression analysis.

“Right now, the only thing we can basically say is that there’s a trend for people with cystic fibrosis admitted for cardiac causes to have a higher in-hospital mortality and increased rate of discharge to nursing facilities, especially in patients admitted with heart failure,” Bhat said.

“There's an increased need to start screening for cardiovascular risk factors [in patients with cystic fibrosis],” Bhat added.