Effect of heart failure on mortality and clinical outcomes in patients hospitalized with pancreatic cancer.
Authors: Nahidi Seyed Mohammad , Javaid Saad , Aziz Nouman , Ahmad Shahzaib , Ganiyani Mohammad Arfat , Garje Rohan , Seetaram Karthik , Usama Ali , Anwar Waqas , Nabi Waseem , Hussaini Murtaza Syed , Zia Mehwish , Florence Obi Mukosolu , Kaur Mandeep , Zahid Rushan , Ali Adnan , Mushtaq Muhammad Sohail 
Published: July 2024

e16367

Background: Pancreatic cancer (PC) is the fourth leading cause of cancer-related death globally. The impact of HF on clinical outcomes in hospitalized patients with PC remains unknown. Considering the poor prognosis associated with PC, we aim to compare clinical outcomes in PC patients with or without HF. Methods: The research utilized the National Inpatient Sample (NIS) database, covering data from 2019 and 2020. Through this dataset, patients hospitalized with a primary discharge diagnosis of PC and a concurrent secondary diagnosis of HF were identified and a multivariate regression analysis was applied. Our primary outcome was mortality in patients with comorbid heart failure in patients diagnosed with pancreatic cancer compared to pancreatic cancer alone and our secondary outcomes were the length of hospitalization, associated hospitalization cost, and the risk of clinical complications or outcomes such as major depressive disorder, atrial fibrillation, acute coronary syndrome, etc. Baseline patient characteristics were found to be comparable in either group and data hence was not specifically adjusted in this regard. Results: A total of 74,585 patients were hospitalized with PC, of which 5,755 had a concurrent diagnosis of HF. The mean age of patients with HF was 74.43 years, while those without heart failure was 67.97 years. Primary and secondary outcomes were calculated. HF was not found to be an independent predictor of mortality (OR 1.17, 95% CI 0.90-1.53, p=0.22), and there was no significant difference in the length of stay in the hospital between the two groups of patients (1.09, 95% CI 0.59-1.60, p<0.001). However, patients with heart failure had an increased total cost of hospitalization ($18,045, 95% CI 5,697-30,392, p=0.00) and increased odds of worse clinical outcomes such as major depressive disorder (OR 1.26, 95% CI 1.02-1.55, p=0.03), p<0.001), atrial fibrillation (OR 4.59, 95% CI 3.85-5.47), acute coronary syndrome (OR 9.96, 95% CI 4.31-23.01, p<0.001), acute respiratory failure (OR 2.69, 95% CI 2.08-3.47, pneumonia (OR 1.66, 95% CI 1.17-2.36 p=0.00), septic shock (OR 1.54, 95% CI 1.09-2.17, p=0.01), p<0.001), invasive mechanical ventilation (OR 2.70, 95% CI 1.96-3.72, p<0.001), ICU admission (OR 2.18, 95% CI 1.67-2.85, p<0.001), acute kidney injury (OR 1.84, 95% CI 1.56-2.18, p<0.001), and cardiovascular accident (CVA) (OR 2.74, 95% CI 1.37-5.47, p=0.004). Conclusions: HF is not an independent predictor of mortality or prolonged length in PC patients, but it is associated with increased hospitalization costs and adverse clinical outcomes. Implementing careful and aggressive management strategies for addressing HF is necessary to optimize patient quality of life, minimize adverse events, and reduce resource utilization to minimize the costs of hospitalization and improve quality of life.