COVID-19 and NSTEMI Outcomes among Hospitalized Patients in the United States and Racial Disparities in Mortality: Insight from National Inpatient Sample Database
Abstract
:1. Introduction
2. Materials and Methods
2.1. Covariates
- Patient: age, race, sex, comorbidities, insurance status, mean income in patient’s zip code, and disposition.
- Hospital: teaching status, bed size, and region.
- Illness severity: length of stay (LOS), mortality, cost of hospitalization, Elixhauser comorbidity index [7], in-hospital complications, mechanical ventilation, circulatory support, and vasopressor use.
2.2. Study Outcomes
- Intubation and vasopressor use.
- Utilization of percutaneous left ventricular assist device (pLVAD) and intra-aortic balloon pump (IABP).
- Rates of coronary revascularization with percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and systemic thrombolytic therapy.
- Length of stay (LOS).
- Cost of hospitalization.
2.3. In-Hospital Complications
- Mechanical: cardiogenic shock.
- Arrhythmic: atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, sinus bradycardia, first-degree atrioventricular nodal block, second-degree atrioventricular nodal block, third-degree atrioventricular nodal block, transvenous pacing, and permanent pacemaker implantation.
- Inflammatory: pericarditis, myocarditis.
2.4. Statistical Methods
3. Results
3.1. Baseline Characteristics
3.2. In-Hospital Mortality and Secondary Non-Procedural Outcomes
3.3. Invasive Cardiac Procedures and Cardiac Complications
4. Discussion
- Myocardial injury from hemodynamic instability or hypoxemia.
- Inflammatory myocarditis.
- Stress cardiomyopathy.
- Microvascular dysfunction.
- Thrombosis with coronary artery plaque destabilization due to inflammatory hypercoagulability.
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | +COVID 19 | −COVID 19 | p-Value |
---|---|---|---|
Total = 515,565 | n = 23,521 (4.56%) | n = 492,044 (95.44%) | |
Female Sex | 39.92% | 40.82% | 0.21 |
Age Groups | <0.001 | ||
≥18–29 | 0.6% | 0.44% | |
30–49 | 5.46% | 8% | |
50–69 | 32.53% | 40.35% | |
≥70 | 61.42% | 51.21% | |
Race | <0.001 | ||
Caucasian | 51.35% | 70.72% | |
African American | 18.52% | 13.35% | |
Hispanic | 20.52% | 9.5% | |
Asian Or Pacific Islander | 4.36% | 3.04% | |
Native American | 0.72% | 0.49% | |
Other | 4.53% | 2.9% | |
Median Household Income | <0.001 | ||
<49,999 USD | 37.42% | 31.66% | |
50,000–64,999 USD | 26.52% | 27.71% | |
65,000–85,999 USD | 21.57% | 22.64% | |
>86,000 USD | 14.49% | 17.99% | |
Insurance Status | |||
Medicare | 70.87% | 65.33% | |
Medicaid | 9.75% | 9.98% | |
Private | 16.73% | 20.71% | |
Self-Pay | 2.66% | 3.97% | |
Hospital Size | 0.02 | ||
Small | 24.34% | 22.37% | |
Medium | 31.8% | 31.21% | |
Large | 43.86% | 46.41% | |
Hospital Teaching Status | 0.46 | ||
Rural | 9.84% | 9.15% | |
Urban Non-Teaching | 21.26% | 21.19% | |
Urban Teaching | 68.9% | 69.66% | |
Medical Comorbidities | |||
Coronary Artery Disease | 45.39% | 67.43% | <0.001 |
Congestive Heart Failure | 47.32% | 50.84% | <0.001 |
Uncomplicated Hypertension | 27.15% | 32.16% | <0.001 |
Complicated Hypertension | 54.59% | 53.2% | 0.06 |
Uncomplicated Diabetes Mellitus | 14.31% | 13.86% | 0.38 |
Complicated Diabetes Mellitus | 38.99% | 32.4% | <0.001 |
Renal Failure | 38.29% | 32.5% | <0.001 |
Chronic Pulmonary Disease | 24% | 25.47% | 0.02 |
Obesity | 19.73% | 21.49% | 0.005 |
Smoking | 25.47% | 43.76% | <0.001 |
Outcome | +COVID 19 | −COVID 19 | p-Value |
---|---|---|---|
In-Hospital Mortality (n = 44,791) | 37.3% | 7.32% | |
Adjusted Odds Ratio: 4.96 (95% CI: 4.56–5.4) | <0.001 | ||
Mean Cost of Hospitalization (USD) | 149,121 | 110,503 | |
Adjusted Total Cost: 36,136 USD Higher | <0.001 | ||
Mean Length of Stay (Days) | 9.89 | 5.35 | |
Adjusted Length of Stay: 3.57 Days Longer | <0.001 | ||
Disposition | <0.001 | ||
Home | 41.57% | 61.07% | |
Skilled Nursing Facility or Long-Term Acute Care or Nursing Home | 38.77% | 17.33% | |
Home with Healthcare | 17.34% | 19.28% | |
Against Medical Advice | 2.32% | 2.32% |
Month | aOR (95% CI LL-UL) | p Value |
---|---|---|
March | 3.92 (2.56–5.99) | <0.001 |
April | 5.35 (4.11–6.97) | <0.001 |
May | 4.85 (3.5–6.64) | <0.001 |
June | 5.36 (3.69–7.8) | <0.001 |
July | 4.57 (3.47–6.02) | <0.001 |
August | 4.23 (3.15–5.67) | <0.001 |
September | 4.81 (3.45–6.7) | <0.001 |
October | 3.42 (2.56–4.57) | <0.001 |
November | 4.45 (3.54–5.59) | <0.001 |
December | 5.08 (4.2–6.14) | <0.001 |
Variable | +COVID 19 | −COVID 19 | p-Value |
---|---|---|---|
Total Died (n = 44,791) | n = 8773 | n = 36,018 | |
Sex | <0.001 | ||
Male | 62.01% | 56.36% | |
Female | 37.99% | 43.64% | |
Age Groups | |||
≥18–29 | 0.23% | 0.5% | 0.12 |
30–49 | 2.68% | 4.15% | 0.004 |
50–69 | 27.84% | 27.93% | 0.94 |
≥70 | 69.25% | 67.43% | 0.13 |
Race | |||
Caucasian | 47.65% | 70.73% | <0.001 |
African American | 18.1% | 12.71% | <0.001 |
Hispanic | 20.53% | 9.37% | <0.001 |
Asian Or Pacific Islander | 4.36% | 3.73% | <0.001 |
Native American | 0.72% | 0.55% | 0.20 |
Other | 4.54% | 2.93% | <0.001 |
Hospital Teaching Status | |||
Rural | 8.5% | 8.77% | 0.71 |
Urban Non-Teaching | 21.85% | 20.68% | 0.37 |
Urban Teaching | 69.65% | 70.55% | 0.53 |
Procedure | +COVID 19 | −COVID 19 | p-Value |
Mechanical Ventilation | 37.07% | 13.38% | <0.001 |
Vasopressor | 6.51% | 2.52% | <0.001 |
Systemic Thrombolytic Therapy | 0.62% | 0.68% | 0.59 |
Coronary Angiogram | 8.74% | 50.27% | <0.001 |
Coronary Artery Bypass Grafting | 0.68% | 6.24% | <0.001 |
Percutaneous Coronary Intervention | 4.78% | 28.95% | <0.001 |
Intra-Aortic Balloon Pump | 0.55% | 1.73% | <0.001 |
Percutaneous Left Ventricular Assist Device | 0.21% | 0.77% | <0.001 |
Transvenous Pacing | 0.19% | 1.01% | <0.001 |
Permanent Pacemaker Implantation | 0.28% | 0.74% | <0.001 |
Cardiac Complication | |||
Cardiogenic Shock | 4.66% | 4.48% | 0.56 |
Atrial Fibrillation | 23.3% | 18.84% | <0.001 |
Atrial Flutter | 3.72% | 3.22% | 0.06 |
Ventricular Fibrillation | 1.51% | 1.47% | 0.80 |
Ventricular Tachycardia | 6.99% | 5.77% | <0.001 |
Sinus Bradycardia | 3.55% | 3.97% | 0.16 |
First Degree Atrioventricular Block | 1.19% | 1.8% | 0.003 |
Second Degree Atrioventricular Block | 0.45% | 0.59% | 0.19 |
Third Degree Atrioventricular Block | 0.77% | 0.99% | 0.12 |
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Share and Cite
Majeed, H.; Gangu, K.; Sagheer, S.; Garg, I.; Khan, U.; Shuja, H.; Bobba, A.; Chourasia, P.; Shekhar, R.; Avula, S.R.; et al. COVID-19 and NSTEMI Outcomes among Hospitalized Patients in the United States and Racial Disparities in Mortality: Insight from National Inpatient Sample Database. Vaccines 2022, 10, 2024. https://doi.org/10.3390/vaccines10122024
Majeed H, Gangu K, Sagheer S, Garg I, Khan U, Shuja H, Bobba A, Chourasia P, Shekhar R, Avula SR, et al. COVID-19 and NSTEMI Outcomes among Hospitalized Patients in the United States and Racial Disparities in Mortality: Insight from National Inpatient Sample Database. Vaccines. 2022; 10(12):2024. https://doi.org/10.3390/vaccines10122024
Chicago/Turabian StyleMajeed, Harris, Karthik Gangu, Shazib Sagheer, Ishan Garg, Umair Khan, Hina Shuja, Aniesh Bobba, Prabal Chourasia, Rahul Shekhar, Sindhu Reddy Avula, and et al. 2022. "COVID-19 and NSTEMI Outcomes among Hospitalized Patients in the United States and Racial Disparities in Mortality: Insight from National Inpatient Sample Database" Vaccines 10, no. 12: 2024. https://doi.org/10.3390/vaccines10122024
APA StyleMajeed, H., Gangu, K., Sagheer, S., Garg, I., Khan, U., Shuja, H., Bobba, A., Chourasia, P., Shekhar, R., Avula, S. R., & Sheikh, A. B. (2022). COVID-19 and NSTEMI Outcomes among Hospitalized Patients in the United States and Racial Disparities in Mortality: Insight from National Inpatient Sample Database. Vaccines, 10(12), 2024. https://doi.org/10.3390/vaccines10122024