Author information
1 Department of Medicine, North Shore Medical Center, Salem, MA, United States; Department of Medicine, Tufts University Medical School, Boston, MA, United States; School of Public Health, University of Massachusetts Lowell, Lowell, MA, United States. Electronic address: acadejumo@partners.org.
2 School of Public Health, University of Massachusetts Lowell, Lowell, MA, United States.
3 University of Kentucky College of Medicine, Division of Hospital Medicine, Lexington, KY, United States.
4 Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ, United States.
5 Department of Medicine, St. Luke's Hospital, Chesterfield, MO, United States.
6 Brandeis University, Waltham, MA, United States.
7 St. Cloud State University, Plymouth, MN, United States.
8 Division of Cardiology, University of Tennessee Health Science Center, Memphis TN, United States.
9 Department of Medicine, North Shore Medical Center, Salem, MA, United States; Department of Medicine, Tufts University Medical School, Boston, MA, United States.
10 WJB Dorn VAMC Heart and Vascular Institute/USC School of Medicine, Columbia, SC, United States.
Abstract
BACKGROUND:
Cirrhotic cardiomyopathy, hyperammonemia, and hepatorenal syndrome predispose to cardiac arrhythmias in End-stage liver disease (ESLD).
OBJECTIVES:
Among ESLD hospitalizations, we evaluate the distribution and predictors of arrhythmias and their impact on hospitalization outcomes.
METHODS:
We selected ESLD records from the Nationwide Inpatient Sample (2007-2014), identified concomitant arrhythmias (tachyarrhythmias and bradyarrhythmias), and their demographic and comorbid characteristics, and estimated the effect of arrhythmia on outcomes (SAS 9.4).
RESULTS:
Of 57,119 ESLD hospitalizations, 6,615 had arrhythmias with higher odds with increasing age, males, jaundice, hepatorenal syndrome, alcohol use, and cardiopulmonary disorders. The most common arrhythmias were atrial fibrillation, cardiac arrest/asystole, and ventricular tachycardia. After propensity-matching (arrhythmia: no-arrhythmia, 6,609:6,609), arrhythmias were associated with 200% higher mortality, 1.7-days longer stay, $32,880 higher cost, and higher rates of shock, respiratory and kidney failures.
CONCLUSIONS:
Due to worse outcomes with arrhythmias, there is a need for better screening and follow-up of ESLD patients for dysrhythmias.