Mortality and socio-economic outcomes among patients hospitalized for stroke and diabetes in the US: a recent analysis from the National Inpatient Sample

Tabbalat, Aya; Dargham, Soha R.; Suwaidi, Jassim Al; Aboulsoud, Samar; Jerdi, Salman Al; Khalil, Charbel Abi

doi:10.1038/s41598-021-87320-w

Cited by 11 publications

(10 citation statements)

References 36 publications

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“…Despite the increasing prevalence and the worsening of the cardio-metabolic profile in patients with diabetes, we observed a Frontiers in Physiology frontiersin.org significant decline in in-hospital mortality, which has been reported in myocardial infarction (Ahmed et al, 2014;Ali et al, 2022), stroke (Tabbalat et al, 2021), HF (Mekhaimar et al, 2021), and valvular heart disease (Khan et al, 2022). In our study, in-hospital mortality in all patients decreased over time, similar to other reported trends for patients with HCM (Elliott et al, 2006;Maron et al, 2015).…”

Section: Discussionsupporting

confidence: 86%

Diabetes outcomes in heart failure patients with hypertrophic cardiomyopathy

et al. 2022

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Aims: We aimed to assess diabetes outcomes in heart failure (HF) patients with hypertrophic cardiomyopathy (HCM).Methods: The National Inpatient Sample database was analyzed to identify records from 2005 to 2015 of patients hospitalized for HF with concomitant HCM. We examined the prevalence of diabetes in those patients, assessed the temporal trend of in-hospital mortality, ventricular fibrillation, atrial fibrillation, and cardiogenic shock and compared diabetes patients to their non-diabetes counterparts.Results: Among patients with HF, 0.26% had HCM, of whom 29.3% had diabetes. Diabetes prevalence increased from 24.8% in 2005 to 32.7% in 2015. The mean age of patients with diabetes decreased from 71 ± 13 to 67.6 ± 14.2 (p < 0.01), but the prevalence of cardiovascular risk factors significantly increased. In-hospital mortality decreased from 4.3% to 3.2% between 2005 and 2015. Interestingly, cardiogenic shock, VF, and AF followed an upward trend. Age (OR = 1.04 [1.03–1.05]), female gender (OR = 1.50 [0.72–0.88]), and cardiovascular risk factors were associated with a higher in-hospital mortality risk in diabetes. Compared to non-diabetes patients, the ones with diabetes were younger and had more comorbidities. Unexpectedly, the adjusted risks of in-hospital mortality (aOR = 0.88 [0.76–0.91]), ventricular fibrillation (aOR = 0.79 [0.71–0.88]) and atrial fibrillation (aOR 0.80 [0.76–0.85]) were lower in patients with diabetes, but not cardiogenic shock (aOR 1.01 [0.80–1.27]). However, the length of stay was higher in patients with diabetes, and so were the total charges per stay.Conclusion: In total, we observed a temporal increase in diabetes prevalence among patients with HF and HCM. However, diabetes was paradoxically associated with lower in-hospital mortality and arrhythmias.

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Section: Discussionsupporting

confidence: 86%

Diabetes outcomes in heart failure patients with hypertrophic cardiomyopathy

et al. 2022

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“…Among predictors of mortality, it is interesting to note that smoking and dyslipidemia appear to confer a protective effect against mortality, which has previously been documented in other analyses of diabetes patients hospitalized for MI (33), heart failure (34), or stroke in the NIS database (35). This described "smoking paradox" has an unclear etiology, as smoking is an established risk factor in developing vascular disease (36).…”

Section: Discussionmentioning

confidence: 77%

Trends and Outcomes of Aortic Valve Replacement in Patients With Diabetes in the US

Khan

Dargham

Suwaidi

et al. 2022

Front. Cardiovasc. Med.

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AimsWe aimed to assess the trend and outcome of aortic valve replacement in patients with diabetes.BackgroundDiabetes is associated with higher cardiovascular events.MethodsData from the National Inpatient Sample was analyzed between 2012 and 2017. We compared hospitalizations and in-hospital cardiovascular outcomes in patients with diabetes to those without diabetes, hospitalized for aortic valve replacement.ResultsIn diabetes patients undergoing TAVR, the mean age of participants decreased from 79.6 ± 8 to 67.8 ± 8, hospitalizations increased from 0.97 to 7.68/100,000 US adults (p < 0.002 for both). There was a significant temporal decrease in mortality, acute renal failure (ARF), and stroke. Compared to non-diabetic patients, those with diabetes had a higher risk of stroke, ARF, and pacemaker requirement [adjusted OR = 1.174 (1.03–1.34), 1.294 (1.24–1.35), 1.153 (1.11–1.20), respectively], but a similar adjusted mortality risk. In diabetes patients undergoing sAVR, the mean age of participants decreased from 70.4 ± 10 to 68 ± 9 (p < 0.001), hospitalizations dropped from 7.72 to 6.63/100,000 US adults (p = 0.025), so did mortality, bleeding, and ARF. When compared to non-diabetes patients, those with diabetes were older and had a higher adjusted risk of mortality, stroke, and ARF [adjusted OR= 1.115 (1.06–1.17), 1.140 (1.05–1.23), 1.217 (1.18–1.26); respectively].ConclusionThe recent temporal trend of aortic valve replacement in patients with diabetes shows a significant increase in TAVR coupled with a decrease in sAVR. Mortality and other cardiovascular outcomes decreased in both techniques. sAVR, but not TAVR, was associated with higher in-hospital mortality risk.

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“…Contrary to our expectation, several cardio-metabolic risk factors such as hypertension, dyslipidemia, obesity, and strikingly smoking were associated with lower mortality risk. Nevertheless, this paradoxical association has been previously reported in the NIS database in studies assessing the outcome of diabetes patients hospitalized either for MI (Ahmed et al, 2014), heart failure (Mekhaimar et al, 2021), or stroke (Tabbalat et al, 2021). This might be since patients with several risk factors are usually given more cardioprotective medications and have their treatments intensified.…”

Section: Discussionmentioning

confidence: 90%

Temporal Trends in Outcomes of ST-Elevation Myocardial Infarction Patients With Heart Failure and Diabetes

et al. 2022

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AimsWe aimed to assess temporal trends in outcomes of ST-elevation myocardial infarction (STEMI) patients with diabetes and heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) and compared both groups.MethodsData from the National Inpatient Sample was analyzed between 2005 and 2017. We assessed hospitalizations rate and in-hospital mortality, ventricular tachycardia (VT), ventricular fibrillation (VF), atrial fibrillation (AF), cardiogenic shock (CS), ischemic stroke, acute renal failure (ARF), and revascularization strategy. Socio-economic outcomes consisted of the length of stay (LoS) and total charges/stay.ResultsHospitalization rate steadily decreased with time in STEMI patients with diabetes and HFrEF. Mean age (SD) decreased from 71 ± 12 to 67 ± 12 (p < 0.01), while the prevalence of comorbidities increased. Mortality was stable (around 9%). However, VT, VF, AF, CS, ischemic stroke, and ARF significantly increased with time. In STEMI patients with HFpEF and diabetes, the hospitalization rate significantly increased with time while mean age was stable. The prevalence of comorbidities increased, mortality remained stable (around 4%), but VF, ischemic stroke, and ARF increased with time. Compared to patients with HFrEF, HFpEF patients were 2 years older, more likely to be females, suffered from more cardio-metabolic risk factors, and had a higher prevalence of cardiovascular diseases. However, HFpEF patients were less likely to die [adjusted OR = 0.635 (0.601-0.670)] or develop VT [adjusted OR = 0.749 (0.703-0.797)], VF [adjusted OR = 0.866 (0.798-0.940)], ischemic stroke [adjusted OR = 0.871 [0.776-0.977)], and CS [adjusted OR = 0.549 (0.522-0.577)], but more likely to develop AF [adjusted OR = 1.121 (1.078-1.166)]. HFpEF patients were more likely to get PCI but less likely to get thrombolysis or CABG. Total charges per stay increased by at least 2-fold in both groups. There was a slight temporal reduction over the study period in the LoS of the HFpEF.ConclusionWhile hospitalizations for STEMI in patients with diabetes and HFpEF followed an upward trend, we observed a temporal decrease in those with HFrEF. Mortality was unchanged in both HF groups despite the temporal increase in risk factors. Nevertheless, HFpEF patients had lower in-hospital mortality and cardiovascular events, except for AF.

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Mortality and socio-economic outcomes among patients hospitalized for stroke and diabetes in the US: a recent analysis from the National Inpatient Sample

Cited by 11 publications

References 36 publications

Diabetes outcomes in heart failure patients with hypertrophic cardiomyopathy

Diabetes outcomes in heart failure patients with hypertrophic cardiomyopathy

Trends and Outcomes of Aortic Valve Replacement in Patients With Diabetes in the US

Temporal Trends in Outcomes of ST-Elevation Myocardial Infarction Patients With Heart Failure and Diabetes

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