Deshmukh, A D

Abstract Introduction Sarcoidosis is a multisystem disorder characterized by an autoimmune response to an unidentified antigen in genetically susceptible persons. Despite clinically detectable cardiac manifestations of sarcoidosis occurring in approximately 5% of patients, recent studies have revealed cardiac involvement to be at 25% in patients with the disease, highlighting the fact that cardiac involvement in sarcoidosis is much more common than was once thought to be. Purpose With cardiac involvement in sarcoidosis being increasingly recognized due to the availability of advanced cardiac imaging, large scale data regarding in-hospital mortality and clinical outcomes of patients admitted with cardiac sarcoidosis (CS) is lacking. Our study aimed to fill this knowledge gap by analyzing demographics and in-hospital outcomes of a large cohort of patients admitted with CS across the United States (US). Methods We analyzed data from the national inpatient sample (NIS) database between October 2015 to December 2018 to identify patients who had been admitted with primary and secondary diagnoses of CS. The NIS is an administrative database sponsored by the Agency for Healthcare Research and Quality consisting of data from 46 participating states, representing more than 95% of the US population and providing nationwide estimates of over 35 million hospitalizations annually. The NIS uses de-identified hospital discharges as samples and hence no additional ethical committee approval was required. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code D86.85 was used to identify hospitalizations with CS in patients aged 18 years or older. SAS 9.4 (SAS Institute, Inc, Cary, NC) was used for statistical analyses. Results A total of 4275 patients were included in the analysis. A higher proportion of patients with CS were females (62.43% vs. 37.57%). Hypertension was the most common comorbidity (43.99%), followed by hyperlipidemia (39.21%) and chronic kidney disease (26.95%). All-cause in-hospital mortality was 2.57%. Atrial fibrillation (AF) was the most common arrhythmia (28.12%), followed by ventricular tachycardia (VT) (22.52%). About 16% of CS patients underwent implantable cardioverter-defibrillator (ICD) implantation during hospital stay. About 42% of patients had concurrent heart failure, out of whom 33.84% had heart failure with reduced ejection fraction (HFrEF). Mean length of hospital stay was 5 days (3–8 days), and the mean cost of hospitalization was $14,177 ($7,121–35,993). Conclusion Given the low prevalence of CS, most of the available studies have been retrospective in nature, based on small sample sizes. Despite being retrospective and cross-sectional, our study has the advantage of being based on a nationally representative sample population, providing key formation on the demographics and in-hospital outcomes of patients with CS. Funding Acknowledgement Type of funding sources: None.

Abstract Background Atrial fibrillation (AF) is the most prevalent arrhythmia among adults worldwide and is associated with an increased risk of heart failure, stroke, and death. Prior studies have highlighted the healthcare burden associated with AF; however, contemporary data is lacking. As AF incidence and prevalence continue to increase due to the aging of the population, current estimates are needed for adequate healthcare resource allocation and policy decisions. Purpose The purpose of our study was to examine the healthcare utilization and cost burden associated with a diagnosis of incident AF in the United States (US). Methods Using the 2017–2020 Optum Clinformatics database, an administrative claims data of commercially insured individuals in the US, adult patients with an incident diagnosis of AF were identified. Adults with AF were matched on demographic and comorbid characteristics to those without AF using a propensity score greedy-matching algorithm with a 1:1 case to control ratio. Outcomes including medical services (inpatient admissions, emergency room [ER] visits, outpatients admissions, other services), utilization (all-cause, cardiovascular [CV]-related), and healthcare costs (sum of all medical services and prescription costs; adjusted for medical inflation and reported in 2021 US $) in the one-year post-incident diagnosis of AF were then compared among the matched cohort. Logistic and general linear modeling assessed healthcare utilization and cost outcomes. Results A total of 159,242 matched participants (79,621 AF cases and 79,621 non-AF controls) were identified. Among patients with AF, the mean age was 74 years, and 51% were females. Among the non-AF controls, the mean age was 73 years, and 50% were females. Patients with incident AF had significantly higher all-cause inpatient visits (relative risk [RR] 1.72; 95% confidence interval [CI]: 1.71–1.73), cardiovascular-related inpatient visits (RR 2.42; 95% CI: 2:41–2:44), as well as cardiovascular-related ER visits (RR: 2.36; 95% CI: 2:30–2:42) as compared to non-AF controls in the 1-year following diagnosis (Figure 1). The one-year mean total healthcare costs were $25,006 (95% CI $24,357-$26,912) higher among patients with AF as compared to non-AF controls ($63,031 vs $38,025, p<0.001). Conclusion Patients with AF had significantly higher medical services use than non-AF controls. The higher medical services utilization among the AF cohort translated into a considerably higher economic burden in this cohort. Timely management and treatment remain critical in alleviating the significant financial and health burden imposed by AF on patients, payers, and providers. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Johnson and Johnson

Abstract Background The effectiveness of catheter ablation as a management modality amongst patients with coexisting atrial flutter (AFL) and heart failure with reduced ejection fraction (HFrEF) is scarcely studied. Methods Appropriate ICD 10 codes were applied to the 2016 and 2017 National Readmission Database (NRD) to isolate patients having coexistent AFL and HFrEF including who had undergone an ablation. All-cause mortality at the end of 1 year was used as a primary outcome. Readmission due to AFL, heart failure (HF) and other causes were secondary outcomes. The hazard ratios were generated using Cox regression analysis while the time to event analysis was demonstrated with the Kaplan Meier curves. Results Out of a total of 9966 patients with AFL and HFrEF, 1980 (24.79%) patients underwent catheter ablation. The primary outcome, all-cause mortality (2.8% vs. 4.6%, HR: 0.610, 95% CI: 0.460–0.808, p=0.001) at the end of 1 year was significantly lower. Significant difference was also noted amongst two groups when it came to secondary outcomes such as readmissions due to AFL (1.6% vs. 6.3%, HR: 0.247, 95% CI: 0.173–0.354, p<0.001), HF (8.2% vs. 11.4%, HR: 0.693, 95% CI: 0.587–0.819, p<0.001) and other causes (29.4% vs. 37.1%, HR: 0.735, 95% CI: 0.673–0.804, p<0.001) Conclusion Ablative intervention amongst AFL patients with concomitant HFrEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to AFL, HF and other causes at the end of one year. Outcomes of AFL and HFrEF Funding Acknowledgement Type of funding source: None