Department of Internal Medicine, Rochester General Hospital, Rochester, New York.
Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, Illinois.
Am J Cardiol. 2021 Mar 15;143:125-130. doi: 10.1016/j.amjcard.2020.12.024. Epub 2020 Dec 24.
Cardiac involvement in amyloidosis is associated with a poor prognosis. Data on the burden of arrhythmias in patients with cardiac amyloidosis (CA) during hospitalization are lacking. We identified the burden of arrhythmias using the National Inpatient Sample (NIS) database from January 2016 to December 2017. We compared patient characteristics, outcomes, and hospitalization costs between CA patients with and without documented arrhythmias. Out of 5,585 hospital admissions for CA, 2,020 (36.1%) had concurrent arrhythmias. Propensity-score matching for age, sex, income, and co-morbidities was performed with 1,405 CA patients with arrhythmias and 1,405 patients without. The primary outcome of all-cause mortality was significantly higher in CA patients with arrhythmia than without(13.9% vs 5.3%, p-value <0.001). Atrial fibrillation (AF) was the most common (72.2%) arrhythmia in CA patients with concurrent arrhythmia. The secondary outcomes of AF-related mortality (11.95% vs 9.16%, p-value = 0.02) and acute and acute on chronic as heart failure (HF) exacerbation (32.38% vs 24.91%, p-value <0.0001) were significantly higher in CA and concurrent arrhythmia compared with CA patients without. The total length of hospital stay (6[3 to 12] vs 5[3 to 10], p-value <0.001) and cost of hospitalization were ($ 15,086[7,813 to 30,373] vs $ 12,219[6,865 to 23,997], p-value = 0.001) were significantly greater among CA with arrhythmia compared with those without. These data suggest that the presence of arrhythmias in CA patients during hospital admission is associated with a poorer prognosis and may reflect patients with a higher risk of HF exacerbation and mortality.
心脏淀粉样变性与预后不良有关。目前尚缺乏心脏淀粉样变性（CA）患者住院期间心律失常负担的数据。我们使用 2016 年 1 月至 2017 年 12 月的国家住院患者样本（NIS）数据库来确定心律失常的负担。我们比较了有和无记录心律失常的 CA 患者的患者特征、结局和住院费用。在 5585 例 CA 住院患者中，有 2020 例（36.1%）同时存在心律失常。对年龄、性别、收入和合并症进行倾向评分匹配，有 1405 例 CA 伴心律失常患者和 1405 例无心律失常患者。伴有心律失常的 CA 患者的全因死亡率显著高于无心律失常患者（13.9%比 5.3%，p 值<0.001）。心房颤动（AF）是 CA 伴心律失常患者中最常见的心律失常（72.2%）。伴有心律失常的 CA 患者的次要结局包括 AF 相关死亡率（11.95%比 9.16%，p 值=0.02）和因急性心力衰竭（HF）恶化（32.38%比 24.91%，p 值<0.0001）显著高于不伴有心律失常的 CA 患者。伴有心律失常的 CA 患者的住院总时间（6[3 至 12]比 5[3 至 10]，p 值<0.001）和住院费用（$15086[7813 至 30373]比 $12219[6865 至 23997]，p 值=0.001）均显著高于不伴有心律失常的 CA 患者。这些数据表明，CA 患者住院期间存在心律失常与预后较差有关，可能反映出 HF 恶化和死亡率较高的患者。
