Introduction: Depression and Anxiety are prevalent among patients with cardiovascular diseases. However, their impact on important clinical outcomes, such as length of hospital stay (LOS) and mortality, is incompletely understood. Objective: Examine the magnitude and impact of major depressive disorder (MDD) and anxiety on LOS and in-hospital mortality in patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI). Hypothesis: Patients with MDD or anxiety will have poorer clinical outcomes after PCI. Methods: Data were obtained from the National Inpatient Survey (NIS). Admissions in 2017 with a primary diagnosis of ACS and undergoing PCI were identified based on ICD10 codes. Patients with MDD or anxiety were further delineated with ICD10 codes. The association between MDD or anxiety and LOS and in-hospital mortality was analyzed using linear and logistic regression models, respectively. Various sociodemographic (age, race, sex, income), clinical (history of hypertension, hyperlipidemia, stroke, peripheral artery disease, valvular heart disease, chronic kidney disease, anemia, obesity, smoking) and hospital-level (region, location, payer type) factors were adjusted for in the analysis. Results: Among 130,712 patients admitted for ACS who underwent PCI, the prevalence of MDD and anxiety were 8.7% (n=11,303) and 10.8% (n=14,066), respectively. Patients were on average aged 67 years (SD=13.5), 38% were females, and 73% non-Hispanic White. Overall, the mean LOS was 4.4 days (SD=5.4) and 4.7% of patients died while hospitalized. Patients with MDD (4.6 vs 4.4, p=0.001) or anxiety (4.7 vs 4.4, p=0.001) had longer LOS than those without these conditions. Contrary to our hypothesis, patients with MDD (OR: 0.82; 95% CI: 0.73-0.91) or anxiety (OR: 0.72; 95% CI: 0.64-0.79) had significantly lower odds of mortality than those without MDD or anxiety after adjusting for several factors of prognostic importance. Conclusions: Among ACS patients who underwent PCI, MDD and anxiety were associated with increased LOS but paradoxically lower in-hospital mortality. These findings reinforce the need for future investigations to evaluate the impact of psychological factors on clinical outcomes in ACS patients who undergo PCI.

Introduction: Atrial Flutter is an abnormal heart rhythm affecting the heart's upper chamber. It has comparative stroke risk to atrial fibrillation but differs in the arrhythmia's origin. There is Paucity of data comparing the relationship between obesity and atrial flutter. This study aims to bridge that gap. Methods: We analyzed the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS was searched for hospitalized adult patients with atrial flutter as a principal diagnosis with and without obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary outcomes were the rate of catheter ablation, cardiogenic shock (CS), cardiac arrest (CA), total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. Results: About 1,891,479 patients were admitted for Atrial Flutter, 21% (398,040) had underlying Obesity. Cohorts with Obesity vs No Obesity had a mean age of 64.4 years [CI 64.3 - 64.5] vs 72.2 years [CI 72.1 - 72.3]; male (52.4% vs 50.4%), female (47.6% vs 49.6%); white (79.8% vs 82.2%), black (11.0% vs 7.8%), and Hispanic (6.2% vs 5.9%). Compared to patients without Obesity, patients admitted with coexisting Obesity had a statistically significant decrease in mortality (0.47% vs 0.95% aOR 0.72, 95% CI 0.64 - 0.81, P 0.001), CA (0.33% vs 0.42%, P=0.003), and CS (0.58% vs 0.61%, P<0.001) compared to those without obesity. The obesity cohorts also had a statistically significant increase in rates of catheter ablation (aOR 1.18, P<0.001), LOS (aIRR 1.05, P<0.001) and THC (aIRR 1.08, P<0.001). Conclusion: Patients admitted primarily for Atrial Flutter with co-existing Obesity had lower inpatient mortality, CA, and CS. There was a statistically significant increase in the rates of catheter ablation, LOS and THC among the obese group. Additional studies are required to elaborate on the management of this patient group.

Background: Body mass index (BMI), has been shown to be related to major adverse cardiovascular events, and overall mortality after percutaneous coronary intervention (PCI). However, the relationship between BMI, and important cardiovascular outcomes, as well as healthcare utilization have not been extensively explored in a national sample. Objectives: Examine the relationship between BMI and in-hospital mortality, cardiogenic shock, cardiac arrest, length of hospital stay (LOS), and cost of hospitalization. Methods: Adults who had a primary diagnosis of Acute Myocardial Infarction (AMI) who underwent a PCI were identified from the 2016 and 2017 National Inpatient Sample using ICD10 codes. BMI was classified BMI into: <20 kg/m 2 , 20-29.9 kg/m 2 (reference), 30-34.9 kg/m 2 (Obesity class I), 35-39.9 kg/m 2 (Obesity class II) and ≥40 kg/m 2 (Obesity class III). Weighted multivariable logistic and linear regression models were used as appropriate. Results: Among 22,953 patients who had AMI and PCI done with reported BMI, 67.9% were male, and 76.2% were Non-Hispanic White. Compared to the reference group, obesity class I, II and III, showed an incremental higher odd of mortality, while patients with BMI <20 kg/m 2 had non-significant lower odds of mortality (Table). Obesity class I and II had lower odds of cardiogenic shock compared to the reference group, while those in the extremes i.e. <20 kg/m 2 and ≥40 kg/m 2 showed no significant difference (Table).The odds of cardiac arrest were not significantly different across the various BMI categories (Table). Obesity class III patients had significantly higher mean LOS and cost of hospitalization compared to the reference group (Table). Conclusion: Our study highlights the relationship between BMI and important clinical outcomes after PCI. These findings buttress the need for healthcare providers to identify high risk patients for worse outcomes after PCI and institute targeted interventions for improved clinical outcomes.

Background: Heart failure is a chronic cardiovascular condition with associated high morbidity, mortality and health-related costs. The disparities of varying sociodemographic factors associated with clinical outcomes in patients with preserved ejection fraction heart failure (HFpEF) is yet to be extensively studied. Aim: To evaluate gender and racial disparities in length of hospital stay (LOS), cost of hospitalization, and in-hospital (IH) mortality in patients with HFpEF. Method: Adults (>18 years) with a primary diagnosis of Acute on Chronic Diastolic dysfunction were identified from the 2016 and 2017 National Inpatient Sample using ICD 10 codes. The relationship between gender or racial groups (Non-Hispanic Whites (NHW)-Ref, Non-Hispanic Blacks (NHB), Hispanics, Asian/Pacific Islanders and Native Americans and study clinical outcomes were assessed using weighted multivariable logistic and linear regression models as appropriate. Results: Among patients with HFpEF (n=595,936), 59.8% were females; 73.4%, 15.6%, 6.6%, 1.9%, and 2.5% were NHW, NHB, Hispanics, Native Americans, and Asians/Pacific Islanders respectively. Females had lower IH mortality [adjusted OR (aOR) 0.9; 95% CI: 0.87 - 0.92) compared to males. Compared to NHW, NHB (aOR 0.81; 95%CI: 0.77 - 0.84) and Hispanics (aOR 0.91; 95%CI: 0.86 - 0.96) had lower odds of IH mortality, while IH mortality in Asian/Pacific Islander and Native American was not significantly different from NHW. Females had lower LOS (mean difference(mD) -0.34 days; 95%CI -0.38 to -0.30) and lower hospital cost (mD -$1967; 95%CI: -2097 to -1838) than males. NHB had similar rates of LOS (mD 0.04days; 95%CI: -0.02 - 0.11) and hospital cost (mD -$176; 95%CI: -412 - 60) compared to NHW. Hispanics had similar rates of LOS but higher hospital cost (mD 0.07 days; 95%CI -0.04 - 0.18; mD $1182; 95%CI: 754 - 1609), Asians/Pacific Islander (mD 0.32 days; 95%CI: 0.14 - 0.49, mD $2846; 95%CI 2173 - 3519) and Native American had a higher LOS and hospital cost compared to NHW (mD 0.49 days; 95%CI: 0.33 - 0.64, mD $2793; 95%CI: 2048 - 3539). Conclusion: Our study highlights racial and gender disparities in important clinical outcomes among patients with HFpEF, buttressing the need to tailor intervention to higher risk groups.

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