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: firstname.lastname@example.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.
Cirrhotic cardiomyopathy, hyperammonemia, and hepatorenal syndrome predispose to cardiac arrhythmias in End-stage liver disease (ESLD).
Among ESLD hospitalizations, we evaluate the distribution and predictors of arrhythmias and their impact on hospitalization outcomes.
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).
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.
Due to worse outcomes with arrhythmias, there is a need for better screening and follow-up of ESLD patients for dysrhythmias.