Relationships between adrenal insufficiency and cardiovascular outcomes in patients with congestive heart failure.

Abstract

Background and aims: Patients with adrenal insufficiency (AI) face elevated risks during various hospitalizations including cardiovascular related admissions. Despite this, limited data exist specifically regarding congestive heart failure (CHF) in the context of AI. This investigation leveraged a comprehensive national database to examine the association between AI and cardiovascular outcomes among patients admitted with CHF.

Methods and results: Admissions for CHF were identified in the 2016-2019 National Inpatient Sample. In-hospital outcomes were compared between patients with and without AI. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, ventricular tachycardia (VT), acute kidney injury (AKI), vasopressor use, mechanical circulatory support (MCS) use, mechanical ventilation use, hospital length of stay (LOS), and total charges. Multivariable regression models were used to adjust for potential confounders. Among 1,270,784 CHF hospitalizations, 3812 (0.3 %) had a diagnosis of AI. AI was associated with higher odds of in-hospital mortality (aOR 2.6, 95 % CI 2.1-3.7), VT (aOR 1.40, 95 % CI 1.1-1.8), AKI (aOR 1.29, 95 % CI 1.10-1.52), the need for vasopressors (aOR 3.3, 95 % CI 1.9-5.63), mechanical ventilation use (aOR 3.8, 95 % CI 2.9-4.99), cardiogenic shock (aOR 3.08, 95 % CI 2.38-3.98), and MCS (aOR 2.12, 95 % CI 1.14-3.95). Patients with AI also had a longer LOS (8.62 days vs. 5.25 days, p < 0.001) and higher total charges ($103,248 vs. $50,280, p < 0.001).

Conclusion: Patients with AI admitted for CHF had higher in-hospital mortality, non-fatal adverse outcomes, and incurred higher hospital charges compared to patients without AI.