e21083 Background: Cardiac tamponade is a serious complication of pericardial effusion and life-threatening cardio-oncological emergency. The prevalence of malignant pericardial effusion varies between 1% and 20% in autopsy studies. Primary lung cancer is the most common cause of metastatic tumor involving the pericardium. The common triggers for pericardial effusion in patients with lung cancer include cancer itself, chemotherapy and radiation therapy. The outcomes of cardiac tamponade in patients with lung cancer remain to be elucidated. Methods: We conducted a retrospective analysis of the 2016 to 2018 Nationwide Inpatient Sample. Adult patients with lung cancer and cardiac tamponade (age ≥ 18) were selected using the ICD-10 diagnosis code. Discharge-level weight analysis was used to produce a national estimate. A univariate and multivariable hierarchical regression analysis was performed to calculate the odds ratio (OR). Results: During the study period, 1,207,580 patients were admitted due to lung cancer of which 7,105 (0.6%) developed cardiac tamponade. Patients with cardiac tamponade tended to be younger (63.2 SE 0.3 vs 69.1 SE 0.2), male (54.5% vs 51.2%) and large proportion of radiation treatment (0.9% vs 0.7%), and smaller proportion of diabetes (18.5% vs 24.2%), chronic kidney disease (4.5% vs 7.6%) and heart failure (15.9% vs 16.2%). After adjusting for age, sex, comorbidity burden and heart failure, cardiac tamponade increased the risk for in-hospital mortality (OR 2.1; 1.9 – 2.5; p < 0.001), major adverse cardiac events (OR 1.6; 1.3 – 2.1; p < 0.001) and acute respiratory failure (OR 2.3; 2.0 – 2.5; p < 0.001). Furthermore, cardiac tamponade was associated with longer length of stay (8.6 SE 0.2 vs 6.0 SE 0.01, p < 0.001) and higher total hospital cost ($118,708.0 SE $4,027.1 vs $65,369.8 SE $170.6). Conclusions: In conclusion, patients with lung cancer who developed cardiac tamponade were associated with poor outcomes including higher in-hospital mortality, MACE, acute respiratory failure, a longer length of stay by 2.6 days, and higher cost of hospitalization. Cardiac tamponade was more common in males and patients who received radiation therapy. Further studies are warranted to develop an optimal management guideline for this cardio-oncological emergency.

Introduction: There has been limited data on impact of socioeconomic status (SES) on temporary mechanical circulation support (MCS) use and in-hospital outcome of cardiogenic shock (CS). Investigating accessibility of advanced medical device and the outcome by SES is imperative to improve public health and develop interventions to reduce healthcare disparities. Methods and Results: We conducted a retrospective analysis of the 2016 to 2018 National Inpatient Sample database and the 2018 to 2019 Nationwide Readmission Database (NRD). Study populations were selected using ICD-10 diagnosis code and ICD-10 procedure code for MCS. SES was evaluated using median household income of patient’s ZIP code and dived into quarter. Discharge-level weight analysis was used to produce a national estimate. We conducted univariate and multivariable hierarchical regression analysis to calculate odds ratio (OR) with STATA 17. During the study period, 466,350 patients were hospitalized with CS of which 30.46% were from 1 st (lowest), 26.62% from 2 nd , 23.65% from 3 rd and 19.27 from 4 th (highest) quartile. 38.58% of CS was secondary to acute coronary artery syndrome. 19.49% (90,905 of 466,350) of CS led to MCS use with IABP, Impeller, percutaneous left ventricular assist device (pLVD) and extracorporeal membrane oxygenation (ECMO) (73.87%;67,154 of 90,905, 26.05%;23,680 of 90,905, 24.35%;22,135 of 90,905 and 1.45%;1,320 of 90,905 respectively). 18.27% (25,435 of 139,235) of lowest quartile patients utilized MCS in contrast to 20.50 %(18,055 of 88,070) of highest quartile. After adjusting for age, sex and comorbid burden, there was a significant higher mortality for the lowest SES quartile as compared to the highest quartile (OR 1.18; 95%CI 1.14-1.24; p < 0.0001). Similarly, the lowest SES quartile was found to be significant indicator for unplanned 30-day readmission (OR 1.16; 95%CI 1.12-1.21; p < 0.0001). Furthermore, there was a lower utilization of MCS among patients from lower SES compared to higher SES (OR 0.87; 95%CI 0.83-0.91; p < 0.0001). Discussion: Patients with lower SES were found to have increased in-hospital mortality, unplanned readmission and decreased utilization of MCS. Further study and public intervention needed to improve CS outcome and accessibility of MCS in low SES patients.