Morgan Michael, Yellapu Vikas, Short Daryn, Ruggeri Cara
Internal Medicine, St. Luke's Hospital, Bethlehem, USA.
Cardiology, St. Luke's University Health Network, Bethlehem, USA.
Cureus. 2024 Oct 1;16(10):e70620. doi: 10.7759/cureus.70620. eCollection 2024 Oct.
Introduction and background Cardiovascular diseases (CVDs) encompass a range of disorders involving coronary artery diseases, valvular heart diseases, myocardial diseases, pericardial diseases, hypertensive heart diseases, heart failure (HF), and pulmonary artery diseases. Given the high prevalence of CVDs, understanding both overall and in-hospital mortality rates from these diseases is crucial. Unsurprisingly, most research, procedures, and new pharmacological interventions aim to reduce these rates. No recent studies have comprehensively detailed in-hospital mortality rates, demographics, and risk factors for all CVDs combined. Yet, in-hospital mortality rates due to CVD significantly impact patients' families and healthcare teams and serve as a critical measure of healthcare system development and effectiveness. Therefore, analyzing in-hospital mortality rates is essential for filling the gap in the recent comprehensive analysis of in-hospital mortality rates, demographics, and risk factors of all CVDs. Method The study used data from the National Inpatient Sample and the Nationwide Inpatient Sample (NIS) Databases of 2021 and HCUP tools. The NIS database extrapolates national estimates based on a stratified sample of 20% of US hospital discharges. Results were expressed as probability and relative risk using the t-test, with a P-value <0.05 being statistically significant. Statistical analyses were done using Stata statistical software version 18 (StataCorp LLC, College Station, TX, US). Results This study included 6,666,752 hospital admissions in the United States. Of these, 2,337,589 patients were admitted with CVDs and related symptoms, with 70,552 deaths occurring during hospitalization, resulting in an in-hospital mortality rate of 3.01% due to CVDs. Our study showed all CVD-induced in-hospital mortality combined was found to have a higher association with diabetes but a lower association with hypertension, hyperlipidemia, alcohol, and smoking. Conclusion The highest rates of cardiovascular disease in-hospital mortality are cardiac arrest, rupture of the cardiac wall as a complication of acute myocardial infarction, cardiogenic shock, rupture of papillary muscle as a complication of acute myocardial infarction, and rupture of chorda tendinea as a complication of acute myocardial infarction. The most common causes of CVD in-hospital mortality are non-ST-elevation myocardial infarction (NSTEMI) (19.20%), ST-elevation myocardial infarction (STEMI) (17.80%), cardiac arrest (15.10%), hypertensive heart disease with heart failure (12.50%), ventricular fibrillation (4.70%), ventricular tachycardia (3.30%), and aortic stenosis (2.10%). The most common risk factors for CVD in-hospital mortality are age, male gender, and diabetes. Proper diabetes control and management might be the highest preventive measure for all CVD-induced in-hospital mortality.
引言与背景
心血管疾病（CVDs）涵盖一系列病症，包括冠状动脉疾病、心脏瓣膜病、心肌病、心包疾病、高血压性心脏病、心力衰竭（HF）以及肺动脉疾病。鉴于心血管疾病的高患病率，了解这些疾病的总体死亡率和住院死亡率至关重要。不出所料，大多数研究、手术和新的药物干预措施旨在降低这些死亡率。最近没有研究全面详细地阐述所有心血管疾病综合的住院死亡率、人口统计学特征和风险因素。然而，心血管疾病导致的住院死亡率对患者家庭和医疗团队有重大影响，并且是衡量医疗系统发展和有效性的关键指标。因此，分析住院死亡率对于填补近期对所有心血管疾病的住院死亡率、人口统计学特征和风险因素的综合分析空白至关重要。
方法
本研究使用了2021年国家住院样本和全国住院样本（NIS）数据库的数据以及医疗成本和利用项目（HCUP）工具。NIS数据库基于美国20%医院出院病例的分层样本推断全国估计数。结果以概率和相对风险表示，采用t检验，P值<0.05具有统计学意义。使用Stata统计软件版本18（美国德克萨斯州大学城StataCorp有限责任公司）进行统计分析。
结果
本研究纳入了美国6,666,752例住院病例。其中，2,337,589例患者因心血管疾病及相关症状入院，住院期间有七万零五百五十二例死亡，心血管疾病导致的住院死亡率为3.01%。我们的研究表明，所有心血管疾病导致的住院死亡综合起来与糖尿病的关联较高，但与高血压、高脂血症、酒精和吸烟的关联较低。
结论
心血管疾病住院死亡率最高的情况是心脏骤停、急性心肌梗死并发症心脏壁破裂、心源性休克、急性心肌梗死并发症乳头肌破裂以及急性心肌梗死并发症腱索破裂。心血管疾病住院死亡最常见的原因是非ST段抬高型心肌梗死（NSTEMI）（19.20%）、ST段抬高型心肌梗死（STEMI）（17.80%）、心脏骤停（15.10%）、高血压性心脏病伴心力衰竭（12.50%）、心室颤动（4.70%）、室性心动过速（3.30%）和主动脉瓣狭窄（2.10%）。心血管疾病住院死亡最常见的风险因素是年龄、男性性别和糖尿病。适当控制和管理糖尿病可能是预防所有心血管疾病导致的住院死亡的最高效措施。
