Impact of protein-energy malnutrition on mortality, length of stay, and hospitalization costs in patients with heart failure and a history of cancer.

Abstract

e13799 Background: Protein-energy malnutrition (PEM) is a common comorbidity in patients with a history of cancer and significantly worsens outcomes in those with heart failure (HF). This study evaluates the impact of PEM on hospital outcomes and examines sociodemographic and clinical disparities. Methods: This retrospective cross-sectional study analysed the 2021 National Inpatient Sample (NIS). Outcomes included in-hospital mortality, LOS, and TOTCHG. Logistic regression was used for mortality, and linear regression was applied for LOS and TOTCHG, adjusting for age, sex, race, income, Charlson Comorbidity Index (CCI), and hospital characteristics. Results: Of 82,420 hospitalised HF patients with a history of cancer, 2.22% had PEM. Overall mortality was 8.5%, significantly higher in PEM patients (19.95%) compared to non-PEM patients (8.24%; p < 0.001). Adjusted odds of mortality for PEM patients were 2.73 (95% CI: 2.09–3.56; p < 0.001). Among breast cancer patients, mortality was 21.51% in PEM patients versus 6.88% in non-PEM patients (adjusted OR: 3.70; p < 0.001). Mean LOS for all HF patients was 7.37 days, extended to 10.79 days for PEM patients (p < 0.001). TOTCHG averaged $100,012, but PEM patients incurred significantly higher charges ($153,544 vs. $98,803; p < 0.001). PEM was disproportionately observed among low-income, Black, and Hispanic patients, who also experienced worse outcomes. Approximately 29.7% of PEM patients were from the lowest income quartile, and Black and Hispanic patients had higher rates of PEM compared to their White counterparts. Most PEM cases were observed in urban teaching hospitals (79.2%). Conclusions: PEM substantially worsens outcomes in HF patients with a history of cancer, leading to higher mortality, longer hospital stays, and increased costs. Disproportionate impacts on low-income, Black, and Hispanic patients emphasize the urgent need for early nutritional screening and interventions to improve outcomes and reduce disparities. Total Population Breast Cancer Kaposi Sarcoma Mortality (PEM) 19.95% 21.51% 4.9% Mortality (Non-PEM) 8.24% 6.88% 1.9% Mean LOS (PEM) 10.79 days 11.88 days 9.1 days Mean LOS (Non-PEM) 7.29 days 6.63 days 5.7 days Mean TOTCHG (PEM) $ 1,53,544.00 $ 1,53,957.00 $ 1,53,957.00 Mean TOTCHG (Non-PEM) $ 98,803.00 $ 84,106.00 $ 84,106.00