Background Hemochromatosis can lead to heart failure, starting as restrictive cardiomyopathy and resulting in dilated cardiomyopathy if not treated. There is limited literature regarding whether hemochromatosis has an impact on the prognosis of non-rheumatic valvular heart disease (NRVHD). We aimed to establish the prevalence of hemochromatosis in NRVHD patients and its prognostic implications. Methods A retrospective cohort analysis was conducted with National Inpatient Sample 2016-2019. Primary outcome was the effect of hemochromatosis on prognosis of patients with NRVHD. Secondary outcomes were the independent predictors of mortality which were calculated with multivariate logistic regression analysis. Results 120,425 patients had a diagnosis of hemochromatosis with a prevalence of 0.085%, out of these 3.82% (n=4595) had NRVHD. Mean age was 65.4 years, 59% patients were males, 75% were white, and 18% were black. For individual valvular involvement, we observed that aortic valve was affected in 1.84% patients (n=2210), mitral valve in 1.82% patients (n=2195), tricuspid valve in 0.4% patients (n=485) and pulmonic valve in 0.13% patients (n=155). Hemochromatosis was associated with significantly lower odds of mortality of 53% in patients with non-rheumatic (NR) aortic valve disease (OR 0.47, CI 0.22 - 0.99, p=0.04). This association of hemochromatosis with reduction in mortality was not seen in patients with NR mitral (OR 0.49, p=0.06), tricuspid (OR 0.76, p=0.6), or pulmonary valve disease. The independent predictors of mortality in patients with hemochromatosis and NRVHD were acute liver failure (OR 5.4, p=0.05) and female gender (OR 3.7, p=0.02). Among the patients with hemochromatosis and NR aortic valve disease 8.3% underwent transcatheter while 6.1% underwent surgical aortic valve replacement. Conclusions Prevalence of hemochromatosis with co-morbid NRVHD is 3.82%. The independent predictors of mortality in this patient population are acute liver failure and female gender. Hemochromatosis is associated with 53% lower odds of mortality in patients with NR aortic valve disease. Extensive research and further studies are required to explore the possible causes for the observed reduced mortality.

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