Outcomes of heart failure hospitalizations among patients with malignant carcinoid tumors.

Abstract

e16356 Background: Malignant carcinoid tumor (MCT) is a neuroendocrine neoplasm which is estimated to affect the heart in about 50% of patients. Carcinoid heart disease predominantly affects the tricuspid valve and pulmonary valve resulting in heart failure. There is a paucity of data regarding the outcomes of malignant carcinoid tumor-related heart failure hospitalizations. We aimed to study the impact of malignant carcinoid tumors on heart failure admissions. Methods: The National Inpatient Sample (NIS), a component of the Healthcare Cost and Utilization Project (HCUP) was queried to identify adult (aged ≥ 18 years) hospitalizations with a primary diagnosis of heart failure. The cohort was stratified based on the presence of malignant carcinoid tumors. The primary outcome studied was all-cause mortality. Secondary outcomes include length of stay and cost of hospitalization. Multivariate logistic regression was performed, adjusting for patient characteristics to evaluate outcomes. An alpha error of 0.05 was accepted for all analyses. Results: Among about 1,462,753 HF hospitalizations, 215 (0.01%) were related to MCT. Those with MCT-related HF were younger (65 vs 70 years; p = 0.014). MCT-related HF admissions had higher frequency of cardiogenic shock (9.3 vs 3.3%, P = 0.03), vasopressor support requirement (4.7 vs 0.8%), and anemia (48.8 vs 31.2%, P = 0.014). However, they had lower rates of strokes, COPD, and smoking compared HF admissions without MCT. The proportion of atrial fibrillation, hypertension, peripheral vascular disease, diabetes, and obesity were similar between both groups. There was a tendency towards increased mortality odds in MCT-related HF hospitalizations, however, this was not significant (aOR: 2.52, p = 0.12). There was also a tendency towards increased odds of prolonged hospital stay (aOR: 1.41; P = 0.28) and higher hospitalization cost (aOR: 1.43; P = 0.13) compared to those without MCT. Conclusions: Heart failure in those with MCT is extremely rare. It was associated with higher rates of cardiogenic shock with a tendency toward higher odds of overall hospitalization mortality. Efforts are needed towards improving outcomes in MCT populations with heart failure. Total Heart FailureHospitalizations: 1,462,753 With MCT (%)N = 215 (0.01%) Without MCT (%)N = 1,462,538 (99.09%) P- value Mean Age 65.3 years 70.4 years 0.014 Gender 0.05  Male 37.2% 52.5%  Female 62.8% 47.5% Race/Ethnicity 0.57  Non-Hispanic White 60.5 68.2  Non-Hispanic Black 20.9 16.4  Hispanic 11.6 7.2  Non-Hispanic Other 7.0 8.1