Sickle cell disease (SCD) predominantly affects African-Americans (AAs) in the United States (US). Due to increasing life expectancy in developed countries, SCD-associated cardiomyopathy is typically seen in adults. The aim of this study was to distinguish hospitalization for this phenotype from traditional heart failure (HF) in AAs. We used the National Inpatient Sample (NIS) database to identify HF hospitalizations in AAs between 2005 and 2014 and stratified them according to SCD status. We compared the characteristics and outcomes before and after matching in a 1:3 ratio for age, gender, insurance, smoking status and admission year. Amongst the 1,195,718 HF admissions in AAs, SCD accounted for 7835. The age (mean ± SD) in the SCD cohort was significantly younger (45.66 ± 13.2) vs non-SCD (64.8 ± 15.2), p<0.001. SCD adults had significantly higher rates of pulmonary hypertension (PH), deep vein thrombosis, and pulmonary embolism while non-SCD adults had higher rates of cardiogenic shock and respiratory failure requiring intubation. The national hospitalization rate for HF in AAs increased from 151 to 257 per million between 2005 and 2011 before declining to 241 per million in 2014. There was a decrease in in-hospital mortality in AAs from 4.8% in 2005 to 3.6% in 2014. We also identified independent predictors of in-hospital mortality in SCD with HF. In conclusion, we described hospitalizations for an emerging heart failure phenotype in AAs. Although there is a national decreasing rate of HF hospitalizations in the US, this may not be reflective of the AA population.
Background: Heart failure (HF) remains one of the leading causes of death in the United States. While many large-scale studies show a positive relationship between cardiovascular mortality and body mass index (BMI), several studies have also observed lower mortality rates among obese HF patients. Therefore, we sought to assess the impact of BMI on in-hospital outcomes in patients admitted with HF.Methods: Patients hospitalized with congestive heart failure (CHF) diagnosis between 2005 and 2014 were identified from the US National Inpatient Sample database using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The sample was divided into three groups based on their BMI. In-hospital outcomes were assessed in different groups and sub-groups.Results: We identified 8,674,190 patients admitted with a primary diagnosis of HF, out of which 1.8% had BMI between 30 and 39.9 kg/m 2 and 3.7% had BMI >40 kg/m 2 . In-hospital mortality was reported in 5.6% of patients with BMI <30 kg/m 2 , compared to 2.3% in those with BMI 30-39.9 kg/m 2 and 3.1% in the group with BMI >40 kg/m 2 . After adjusting for various confounders, in-hospital mortality was lower in those with BMI 30-39.9 kg/m 2 than those with BMI <30 kg/m 2 (OR 0.56; CI 0.51-0.62). Similarly, in-hospital mortality was lower in those with BMI >40 kg/m 2 than those with BMI <30 (OR 0.87; CI 0.81-0.92). Conclusion:Even though this study supports the findings of previous smaller studies illustrating the existence of the "obesity paradox" in HF hospitalizations, the pathogenesis behind this paradoxical effect is still unclear.
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