Article Text

Download PDFPDF
In-hospital outcomes and prevalence of comorbidities in patients with infective endocarditis with and without heart blocks: Insight from the National Inpatient Sample
  1. Shakeel M Jamal1,
  2. Asim Kichloo2,
  3. Michael Albosta1,
  4. Beth Bailey1,
  5. Jagmeet Singh3,
  6. Farah Wani4,
  7. Muhammad Shah Zaib1,
  8. Muhammad Ahmad1,
  9. Muhammad Dilawar Khan1,
  10. Ronak Soni5,
  11. Michael Aljadah6,
  12. Hafiz Waqas Khan7,
  13. Mahin Khan7,
  14. Muhammad Z Khan8
  1. 1 Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
  2. 2 Department of Internal Medicine, CMU Medical Education Partners, Saginaw, Michigan, USA
  3. 3 Department of Internal Medicine/Division of Nephrology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
  4. 4 Department of Family Medicine, Samaritan Medical Center, Watertown, NY, USA
  5. 5 Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
  6. 6 Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  7. 7 Department of Internal Medicine, Michigan State University, Flint, Michigan, USA
  8. 8 Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
  1. Correspondence to Dr Asim Kichloo, Department of Internal Medicine, CMU Medical Education Partners, Saginaw, Michigan 48602, USA; kichlooasim{at}gmail.com

Abstract

Infective endocarditis (IE) complicated by heart block can have adverse outcomes and usually requires immediate surgical and cardiac interventions. Data on outcomes and trends in patients with IE with concurrent heart block are lacking. Patients with a primary diagnosis of IE with or without heart block were identified by querying the Healthcare Cost and Utilization Project database, specifically the National Inpatient Sample for the years 2013 and 2014, based on International Classification of Diseases Clinical Modification Ninth Revision codes. During 2013 and 2014, a total of 18,733 patients were admitted with a primary diagnosis of IE, including 867 with concurrent heart blocks. Increased in-hospital mortality (13% vs 10.3%), length of stay (19 vs 14 days), and cost of care ($282,573 vs $223,559) were found for patients with IE complicated by heart block. Additionally, these patients were more likely to develop cardiogenic shock (8.9% vs 3.2%), acute kidney injury (40.1% vs 32.6%), and hematologic complications (19.3% vs 15.2%), and require placement of a pacemaker (30.6% vs 0.9%). IE and concurrent heart block resulted in increased requirement for aortic (25.7% vs 6.1%) and mitral (17.3% vs 4.2%) valvular replacements. Conclusion was made that IE with concurrent heart block worsens in-hospital mortality, length of stay, and cost for patients. Our analysis demonstrates an increase in cardiac procedures, specifically aortic and/or mitral valve replacements, and Implantable Cardiovascular Defibrillator/Cardiac Resynchronization Therapy/ Permanent Pacemaker (ICD/CRT/PPM) placement in IE with concurrent heart block. A close telemonitoring system and prompt interventions may represent a significant mitigation strategy to avoid the adverse outcomes observed in this study.

  • endocarditis
  • heart block

Statistics from Altmetric.com

Footnotes

  • Contributors SMJ and AK are credited with substantial contribution to the design of the work, acquisition and interpretation of data, drafting the manuscript, revision for important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work. MA is credited with substantial contribution to interpretation of data, literature review of all sections discussed, drafting the manuscript, final approval of the version published, and agreement on accountability for all aspects of the work. BB is credited with substantial contribution to acquisition, analysis, and interpretation of data, revision for critically important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work. JS, FW, MSZ, MA, and MDK are credited with interpretation of data, literature review of all sections, revision for important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work. RS, MA, HWK, MK, and MZK are credited with interpretation of data, literature review specifically for the discussion section, revision of the work for critically important intellectual content, final approval of the version published, and agreement on accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Our institution does not require ethical approval for NIS database studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The Healthcare Cost and Utilization Project (HCUP) databases are limited data sets. HCUP databases conform to the definition of a limited data set. A limited data set is healthcare data in which 16 direct identifiers, specified in the Privacy Rule, have been removed. Please see the following web link: https://www.hcup-us.ahrq.gov/DUA/dua_508/DUA508version.jsp.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.