Right-sided circulatory failure without pulmonary embolism in hospitalized cancer patients: National burden and inpatient outcomes.

Abstract

e24033 Background: In hospitalized patients with cancer, acute right-sided circulatory failure is highly attributedto pulmonary embolism. However, right-heart failure may occur in the absence of pulmonaryembolism due to cancer-related inflammation, anemia, pulmonary vascular injury, ortreatment-associated cardiopulmonary toxicity. The burden and prognostic significance ofpulmonary embolism-negative right-sided circulatory failure in contemporary oncologyhospitalizations remain poorly defined. Methods: A serial cross-sectional analysis was conducted using adult hospitalizations with a principaldiagnosis of malignancy in the 2018 to 2022 Healthcare Cost and Utilization Project NationalInpatient Sample with discharge-level survey weighting. Right-sided circulatory failure withoutpulmonary embolism was defined by diagnoses of cor pulmonale or pulmonary heart disease(ICD-10-CM I27*) or right heart failure (I50.81) in the absence of pulmonary embolism (I26*).Outcomes included in-hospital mortality, shock, intensive care unit utilization proxy defined byshock or mechanical ventilation, mechanical ventilation, All Patient Refined Diagnosis RelatedGroup severity, length of stay, and hospitalization cost. Survey-weighted multivariableregression adjusted for demographics, payer, ZIP-code income quartile, admission type, cancersubtype, hospital characteristics, region, and year. Sensitivity analyses excluded all pulmonaryembolism admissions. Results: Among 961,848 unweighted cancer hospitalizations representing approximately 4.6 millionadmissions nationally, right-sided circulatory failure without pulmonary embolism occurred in1.9% of admissions. After adjustment, pulmonary embolism-negative right-sided circulatoryfailure was independently associated with shock (odds ratio 2.24, 95% CI 2.06 to 2.44),intensive care unit utilization (odds ratio 2.10, 95% CI 1.98 to 2.23), mechanical ventilation(odds ratio 2.10, 95% CI 1.96 to 2.25), and extreme All Patient Refined Diagnosis RelatedGroup severity (odds ratio 2.19, 95% CI 2.03 to 2.37). In-hospital mortality was higher (oddsratio 1.57, 95% CI 1.48 to 1.66). Length of stay increased by an adjusted mean of 1.62 days(95% CI 1.47 to 1.77), and hospitalization costs were higher by $5,913 (95% CI $5,079 to$6,747). Associations persisted after exclusion of all pulmonary embolism admissions. Conclusions: Right-sided circulatory failure without pulmonary embolism affects approximately 1 in 50 cancerhospitalizations and is associated with inpatient deterioration, intensive careutilization, prolonged hospitalization, increased costs, and excess mortality. These findingsidentify a distinct pulmonary embolism-negative right-heart failure phenotype with implicationsfor early inpatient recognition and escalation for oncology hospitalizations.