Introduction: Pulmonary arterial hypertension (PAH) is well defined, however, the trends and disparities have not been studied recently after the update in guidelines. Methods: We utilized National Inpatient Sample Database 2010-2019 to identify the cohort with principal diagnosis of PAH using ICD-9 and 10 codes. Primary outcome analysis included the crude admission rate of PAH per 1,000,000 adult hospitalizations during each calendar year stratified by sex, race, and median household income (MHOI). Secondary outcome analysis included trends in inpatient mortality rate, mean length of hospital stay (LOS), and mean total hospital charges (THC). Results: There were a total of 341 million admissions from 2010-2019 out of which 0.004% (13644) were adults admitted with principal diagnosis of PAH. There was no significant difference in year on year admissions in the last decade (Figure). Most patients were aged 18-65 when diagnosed (OR 1.73, 95% CI 1.55-1.92). Females were twice as likely to be diagnosed with PAH than males (OR 2.40, 95% CI 2.17-2.64). African Americans (OR 1.35, 95% CI 1.21-1.50) and Asian/Pacific Islander (OR 1.22, 95% CI 1.04-1.42) were at slightly more risk of PAH. There was no significant difference in inpatient mortality among patients with principal diagnosis of PAH over the last decade. Although mortality increased with increasing age (OR 1.29. 95% CI 1.29-3.33 for age > 65) (OR 1.79, 95% CI 1.45-2.77) but did not defer when stratified for gender , race or year. Conclusion: Admissions for principal diagnosis of pulmonary arterial hypertension have remained unchanged over the last decade. Female sex, age and median house hold income is associated with increased risk for PAH.

Introduction: Heart failure is a common clinical syndrome that leads to high volumes of hospitalizations and in hospital mortality. Previous studies have attempted to characterize the various reasons for the high rates of morbidity and mortality associated with heart failure. Our study aimed to utilize large database information to identify the most common indicators for and cause of death in patients with heart failure. Methods: Using the National Inpatient Sample database, we analyzed heart failure hospitalizations during the years 2016-2019 and categorized reasons for hospitalization and in-patient mortality using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10). Results: We identified a total of 5,281,210 hospitalizations with heart failure as the principal or secondary diagnosis ICD-10 code. The leading cause for admission was heart failure (65%), followed by sepsis (8.5%), non ST elevation myocardial infarction (NSTEMI) (6.0%), acute chronic obstructive pulmonary disease (COPD) exacerbation (2.5%) and pneumonia (2.2%). There were a total of 161,417 cases of in-hospital mortality in patients with heart failure during this period. The most common reason for mortality was heart failure itself (49.8%), followed by sepsis (41.2%), NSTEMI (12.8%), acute hypoxic respiratory failure (7.8%) and acute-on-chronic hypoxic respiratory failure (5.9%). Conclusion: This study represents the most recent nationwide data on causes for hospitalization and mortality in patients with heart failure across the United States, with the most common cause of both being heart failure itself followed by sepsis and NSTEMI. A better understanding of why patients are hospitalized may lead to changes in practice to prevent admissions as well as in-hospital management to ultimately prevent death.

Introduction: Atrial fibrillation is a common clinical syndrome that leads to high volumes of hospitalizations and in hospital mortality. Previous studies have attempted to characterize the various reasons for the high rates of morbidity and mortality associated with atrial fibrillation. Our study aimed to utilize large database information to identify the most common indicators for and cause of death in patients with atrial fibrillation. Methods: Using the National Inpatient Sample database, we analyzed atrial fibrillation hospitalizations during the years 2016-2019 and categorized reasons for hospitalization and in-patient mortality using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10). Results: We identified a total of 18,084,144 hospitalizations with atrial fibrillation as the principle or secondary diagnosis ICD-10 code. The most common systems involved were cardiovascular (37%), respiratory (10%), and infectious (10%). Specifically, the leading cause for hospitalization was heart failure (10%) followed by atrial fibrillation (9%) and sepsis (7%), There was a total of 848,579 cases of in-hospital mortality in patients with atrial fibrillation during this period. The most common reason for mortality was sepsis (26%), followed by acute respiratory failure (5%), heart failure (5%), non ST elevation myocardial infarction (NSTEMI) (2%), and pneumonia (1%). Conclusion: This study represents the most recent nationwide data on causes for hospitalization and mortality in patients with atrial fibrillation across the United States. In our analysis, we found that the most common cause of hospitalization was attributed to cardiovascular disease, specifically heart failure, while sepsis was the most common cause of inpatient mortality. A better understanding of why patients are hospitalized may lead to changes in practice to prevent admissions as well as in-hospital management to ultimately prevent death.

Introduction: Transcatheter aortic valve replacement (TAVR) is now firmly established as an alternative to surgical aortic valve replacement in the treatment of aortic stenosis in all risk groups. Sex differences may influence procedural outcomes. Our study aims to contribute further data on the impact of sex differences on patients who underwent TAVR using a nationally representative sample. Methods: Data were obtained from the combined National Inpatient Sample (NIS) 2016 and 2018. The NIS was searched for hospitalization for TAVR procedure using the ICD-10 PCS codes. Patients undergoing the TAVR procedure were then stratified by sex into male and female sex. Outcomes of interest include in-patient mortality, length of stay (LOS), Total hospital charge (THC), Post procedural complication, pacemaker implantation, cardiogenic shock, ischemic stroke, intra-aortic balloon pump insertion, post-procedural infection, and post-procedural kidney disease. Multivariate logistic and linear regression analysis was used accordingly to adjust for possible confounders. Results: There were over 105 million discharges in the combined 2016-2018 NIS database. The database contained hospitalizations for adult patients (aged ≥ 18 years) who were hospitalized for the TAVR procedure. Females had more TAVR procedures compared to men (54.1% vs 45.9%, P<0.0001 and were older than men who underwent TAVR. There was similar in-patient mortality in both group (1.7% vs 1.2%, AOR: 1.21, P=0.072, 95% CI 0.98- 1.51). Women had lower rate of cardiogenic shock (AOR: 0.78, P=0.009, 95% CI 0.65-0.94), pacemaker implantation (AOR: 0.84, P=0.001, 95% CI 0.76-0.93) compared to men. Women had higher odds of post-procedural complications compared to men (AOR: 1.18, P=0.001, 95% CI: 1.07-1.29. There were similar rates of ischemic stroke (AOR: 1.23, P=0.502, 95% CI 0.66-2.31), postprocedural kidney injury (AOR: 1.65, P=0.278, 95% CI 0.66-4.12) in women compared to men. In addition, there was no difference in total charge and length of hospital stay. Conclusions: Women had increased post-procedural complications compared to men in regard to TAVR, however, mortality is similar in both groups. There was no difference in resource utilization and length of stay between both sexes.

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