Prevalence, trends, outcomes, and disparities in hospitalizations for nonalcoholic fatty liver disease in the United States

Background: As the frequency of nonalcoholic fatty liver disease (NAFLD) continues to rise in the United States (US) community, more patients are hospitalized with NAFLD. However, data on the prevalence and outcomes of hospitalizations with NAFLD are lacking. We investigated the prevalence, trends and outcomes of NAFLD hospitalizations in the US. Methods: Hospitalizations with NAFLD were identified in the National Inpatient Sample (2007-2014) by their ICD-9-CM codes, and the prevalence and trends over an 8-year period were calculated among different demographic groups. After excluding other causes of liver disease among the NAFLD cohorts (n=210,660), the impact of sex, race and region on outcomes (mortality, discharge disposition, length of stay [LOS], and cost) were computed using generalized estimating equations (SAS 9.4). Results: Admissions with NAFLD tripled from 2007-2014 at an average rate of 79/100,000 hospitalizations/year (P<0.0001), with a larger rate of increase among males vs. females (83/100,000 vs. 75/100,000), Hispanics vs. Whites vs. Blacks (107/100,000 vs. 80/100,000 vs. 48/100,000), and government-insured or uninsured patients vs. privately-insured (94/100,000 vs. 74/100,000). Males had higher mortality, LOS, and cost than females. Blacks had longer LOS and poorer discharge destination than Whites; while Hispanics and Asians incurred higher cost than Whites. Uninsured patients had higher mortality, longer LOS, and poorer discharge disposition than the privately-insured. Conclusions: Hospitalizations with NAFLD are rapidly increasing in the US, with a disproportionately higher burden among certain demographic groups. Measures are required to arrest this ominous trend and to eliminate the disparities in outcome among patients hospitalized with NAFLD

Abstract P320: Is Co-occurring Endometriosis Among Women With Myocardial Infarction Associated With Worse In-hospital Outcomes? Findings From the Nationwide Inpatient Sample

Background: Recent studies have shown that patients with endometriosis have an increased risk of coronary artery disease. Inflammatory diseases that increase the risk of coronary artery disease have also been shown to worsen outcomes. We sought to evaluate the effect of co-occurring endometriosis among women with myocardial infarction (MI) on stroke, length of stay (LOS) and in-hospital mortality. Methods: Data was obtained from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS). We studied women ages 18 and above hospitalized for MI between 2007 and 2011. Admissions for endometriosis, MI and outcomes data were extracted using ICD-9 CM codes. We estimated weighted frequencies and proportions for all patients admitted for MI, co-occurring endometriosis and for all covariates. We then performed bivariate parametric tests of association as appropriate. In order to evaluate the independent effect of co-occurring endometriosis and MI on stroke, LOS and in-hospital mortality, we constructed multivariate regression models. Results: We found a total of 420,940 hospital admissions for myocardial infarction. Out of these, 80 had co-occurring endometriosis. Women with these co-occurring conditions were more likely to be white (67.5%) and privately insured (53.8%). In adjusted models, compared to those without, women with co-occurring endometriosis and MI did not have a significantly higher risk of stroke (aOR=1.10, 95% CI: 0.27- 4.56) or prolonged LOS (aOR=1.29, 95% CI: 0.45 - 3.04). Risk was not found to be increased for in-hospital mortality (aOR=0.71, 95% CI: 0.26 - 1.95). Conclusion: Our study shows that co-occurring endometriosis among women with MI was not significantly associated with worse in-hospital outcomes. Larger, prospective, studies with longer follow-up time after discharge are needed to further evaluate this association. </jats:p

Abstract 042: Association Between Preexisting Valvular Heart Disease and Takotsubo Cardiomyopathy Among Hospitalized Patients in the United States

Background: The pathogenesis of Takotsubo Cardiomyopathy (TTCM) remains poorly understood. Several case reports have described the occurrence of TTCM in patients with preexisting valvular heart disease (VHD). We sought to examine the association between preexisting VHD and TTCM in hospitalized patients. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), all hospitalizations between 2007 and 2011 with preexisting diagnosis of VHD and admitting diagnosis of TTCM were extracted using ICD-9 CM codes. We compared patients admitted for TTCM who had preexisting VHD to those without. We excluded patients below the age of 18 as well as those diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate logistic regression was used to assess the independent effect of preexisting VHD on both occurrence of TTCM and clinical outcomes (length of stay (LOS), stroke and in-hospital mortality). Results: In our study, 613 (0.06%) out of the 1,084,719 hospitalized patients with preexisting VHD, had TTCM, compared to 13,381 (0.04%) out of the 31,460,000 with no preexisting VHD (p&lt;0.0001). In adjusted models, patients with preexisting VHD had a lower risk of being hospitalized for TTCM in the index hospital admission (adjusted odds ratio (aOR) =0.83, 95% confidence interval (CI) =0.77-0.90), independent of potential demographic, comorbid and lifestyle confounders. However, preexisting VHD was significantly associated with longer LOS (aOR=2.59, 95% CI=1.95-3.23), increased stroke rate (aOR=2.49, 95% CI=1.75-3.54) and higher in-hospital mortality (aOR=1.48, 95% CI=1.05-2.09). Conclusion: In this large, nationwide study, preexisting VHD was associated with worse clinical outcomes in patients hospitalized for TTCM. Our results can guide future clinical decision-making regarding prompt risk factor identification for poor prognosis in TTCM patients. Future prospective studies are needed to further evaluate this association. </jats:p

Abstract P173: Hyperthyroidism Increases the Risk of Takotsubo Cardiomyopathy Among Hospitalized US Patients

Background: The association between hyperthyroidism and Takotsubo Cardiomyopathy (TTCM) has only been reported in isolated case reports and a recent single center study with inconclusive results. It is known that elevated thyroid hormone causes an increased sympathetic modulation of heart rate. It has also been shown that TTCM occurs in the setting of acute stressful illnesses involving excess catecholamine release. What is unclear is whether hyperthyroid states can predispose to TTCM. This is the first nationwide study of this association. Methods: We used ICD-9 CM codes to extract data from the Nationwide Inpatient Sample database from 2007-2011. Patients with TTCM and coexisting hyperthyroidism were compared with TTCM patients without coexisting hyperthyroidism. We excluded persons below the age of 18 as well as patients diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate logistic regression was used to assess the independent effect of coexisting hyperthyroidism on the occurrence of TTCM. Results: A total of 33,639,230 patients were included, where 123,923 patients had hyperthyroidism while 32,400,000 did not have hyperthyroidism. There were 101 (0.08%) TTCM patients with coexisting hyperthyroidism compared to 13,893 (0.04%) without (p&lt;0.0001). In adjusted models, patients with hyperthyroidism had a higher risk of TTCM in the index hospital admission (aOR=1.43, 95% CI=1.18-1.74), independent of potential demographic, comorbid and lifestyle confounders. Hispanics with hyperthyroidism had the highest risk of TTCM (OR=1.41, 95% CI=1.39-1.44). Conclusion: In this large, nationwide study, hyperthyroidism was associated with increased risk of TTCM. This association was strongest among hispanics. Further research is needed to understand the mechanisms behind this association. </jats:p

Abstract 340: Drug-Eluting Balloon Versus Everolimus-Eluting Stent for Restenosis in a Bare-Metal Stent: A Meta-Analysis of Randomized Trials

Background: In-stent restenosis accounts for major morbidity and mortality among patients treated with Bare-Metal Stents (BMS). Early efforts to treat BMS in-stent restenosis with plain balloon angioplasty and first generation drug eluting stents (DES) have been ineffective, leaving drug-eluting balloon (DEB) and second generation DES, such as everolimus eluting stents (EES), as the only remaining options. For BMS in-stent restenosis, studies performed so far have yielded conflicting results, while prior meta-analyses have been influenced by inclusion of observational studies. This is the first meta-analysis to compare EES versus DEB using results from only randomized controlled trials (RCTs). Methods: A systematic search of PUBMED and EMBASE databases was conducted from first available date to August, 2016 for RCTs comparing DEB with EES. Two reviewers evaluated studies for eligibility and extracted data with binary restenosis rate as the main endpoint. We identified 901 unique citations. Odds ratios were pooled using random-effects modeling. Funnel plots were used to assess publication bias. Heterogeneity was assessed using I 2 statistic. All analysis were performed using Review Manager (RevMan) version 5.3 (Cochrane Collaboration, 2014). Results: Three RCTs met study eligibility criteria, with 684 patients and a mean follow-up of 9.5 months. There were 184 and 185 patients in the EES and DEB arms respectively. In pooled analyses, EES was not superior to DEB in binary restenosis rates (pooled odds ratio: 0.76; 95% confidence interval: 0.25-2.32; P=0.14). Heterogeneity was minimal (I 2 = 49%), and the funnel plot did not suggest publication bias. Conclusion: In patients with BMS in-stent restenosis, there were no significant differences in binary restenosis rates between EES and DEB. Our results can enhance physician decision-making regarding choice of revascularization tool in this patient population. </jats:p

Abstract 514: Sex-Related Disparities in Outcomes After Myocardial Infarction Among Patients With Atrial Fibrillation: Evidence From a Nationwide Study

Background: The overall mortality rate after acute myocardial infarction (AMI) is falling in the United States. However, outcomes remain unacceptably worse in females compared to males. It is not known how coexisting atrial fibrillation (AF) modify outcomes among the sexes. We sought to examine the association of sex with clinical characteristics and outcomes after AMI among patients with AF. Methods: We accessed the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to extract all hospitalizations between 2007 and 2011 for patients above 18yrs with principal diagnosis of AMI and coexisting diagnosis of AF using ICD 9-CM codes. The NIS represents the largest all-payer hospitalization database in the United States, sampling approximately 8 million hospitalizations per year. We also extracted outcomes data (length of stay (LOS), stroke and in-hospital mortality) after AMI among Patients with AF. We then compared sex differences. Univariate and Multivariate analysis were conducted to determine the presence of statistically significant difference in outcomes between men and women. Results: A total of 184,584 AF patients with AMI were sampled, consisting of 46.82% (86,420) women and 53.13% (98,164) men. Compared with men, women with AF and AMI had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.51, 95% CI=1.45-1.59), and higher in-hospital mortality (aOR=1.12, 95% CI=1.09-1.15). However, female gender was not significantly associated with longer LOS (aOR=-0.22, 95% CI= -0.29-(-0.14). Conclusion: In this large nationwide study of a population-based cohort, women experienced worse outcomes after AMI among patients with AF. They had higher in-hospital mortality and increased stroke rates. Our findings highlight the need for targeted interventions to improve these disparities in outcomes. </jats:p

Higher odds of irritable bowel syndrome among hospitalized patients using cannabis

International audienceBACKGROUND: The endogenous cannabinoid system modulates many brain-gut and gut-brain physiologic pathways, which are postulated to be dysfunctional in irritable bowel syndrome (IBS). Herein, we examine the relationship between cannabis use disorder (CUD) and having IBS.PATIENTS AND METHODS: After selecting patients aged 18 years and above from the 2014 Nationwide Inpatient Survey, we used the International Classification of Diseases, 9th ed. codes to identify individuals with CUD, IBS, and the established risk factors for IBS. We then estimated the crude and adjusted odds ratios of having a diagnosis of IBS with CUD and assessed for the interactions of CUD with other risk factors (SAS 9.4). We confirmed our findings in two ways: conducting a similar analysis on a previous Nationwide Inpatient Survey data (2012); and using a greedy algorithm to design a propensity-scored case-control (1 : 10) study, approximating a pseudorandomized clinical trial.RESULTS: Out of 4 709 043 patients evaluated, 0.03% had a primary admission for IBS and 1.32% had CUD. CUD was associated with increased odds of IBS [adjusted odds ratio: 2.03; 95% confidence interval (CI): 1.53-2.71]. CUD was related to higher odds for IBS among males compared with females (3.48; 1.98-6.12 vs. 1.48; 0.88-2.50), and Hispanics and Caucasians compared with Blacks (5.28; 1.77-15.76, 1.80; 1.02-3.18 vs. 1.80; 0.65-5.03). On propensity-matching, CUD was associated with 80% increased odds for IBS (1.82; 1.27-2.60).CONCLUSION: Our findings suggest that CUD is significantly associated with IBS among the general population. Males, Caucasians, and Hispanics might be more impacted by CUD associated IBS. Additional biomedical studies are required to elucidate this relationship