Heart failure in hospitalizations for hematologic malignancies versus solid tumors: National burden and inpatient outcomes, 2018-2022.

Abstract

11074 Background: Heart failure (HF) is a common and morbid comorbidity in oncology. Whether HF burden and prognosis differ between hospitalizations for hematologic malignancies and solid tumors remains incompletely characterized at a national level. This study compared HF prevalence and HF-associated outcomes across these cancer groups. Methods: A serial cross-sectional analysis was conducted using adult hospitalizations in the 2018 to 2022 Healthcare Cost and Utilization Project National Inpatient Sample with discharge-level survey weighting. Cancer hospitalizations were classified by principal diagnosis as hematologic malignancy or solid tumor. HF was identified using ICD-10-CM I50* in any diagnosis field. Outcomes included HF prevalence, in-hospital mortality, intensive care unit utilization, shock, length of stay, and hospitalization cost. Survey-weighted multivariable regression adjusted for demographics, comorbidities, hospital characteristics, and admission factors. Models restricted to HF admissions evaluated associations between cancer type and outcomes within the HF subgroup. Results: Among an estimated 4.81 million cancer hospitalizations nationally, HF prevalence was higher in hematologic malignancies than in solid tumors (13.2% vs 8.0%, p < 0.001). After adjustment, hematologic malignancy was associated with higher odds of HF (adjusted odds ratio (aOR) 1.53, 95% CI 1.50 to 1.57). Among HF hospitalizations, hematologic malignancies had higher mortality (11.7% vs 8.0%), intensive care unit utilization (8.5% vs 7.3%), and shock (3.8% vs 3.4%) (all p < 0.001). In adjusted models restricted to HF admissions, hematologic malignancy remained associated with higher mortality (adjusted odds ratio 1.34, 95% CI 1.26 to 1.42) and intensive care unit utilization (aOR 1.15, 95% CI 1.07 to 1.23). Resource utilization was greater in hematologic malignancy HF admissions, including longer length of stay (12.1 vs 8.3 days) and higher costs ($50,518 vs $30,906; both p < 0.001). Interaction modeling showed no significant effect modification of HF-associated mortality by cancer type. Conclusions: Hospitalizations for hematologic malignancies have higher HF prevalence than solid tumor hospitalizations and demonstrate higher mortality, intensive care utilization, shock, length of stay, and costs among admissions with HF. These findings identify hematologic malignancy hospitalizations as a high-risk context for HF-associated inpatient deterioration and resource use.