Prevalence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) Vs No Macce in Elderly Hospitalized Patients with Amyloidosis; Its Gender and Racial Disparities: A Nationwide Analysis (2016-2020)
Authors: Asfeen Ummul Zohra , Chakilam Rumitha , Parvez Maahin , Avaiya Niyati Shambhubhai , Chauhan Sumit , Kotla Nikhil Kumar , Kondaveety Soumya , Igbenabor Christiana Aina , Thappar Karanbir Singh , Desai Rupak 
Published: December 2024

Background: Understanding the frequency and demographic variations of MACCE (major adverse cardiac and cerebrovascular events) in elderly patients (aged ≥65 years) hospitalized with amyloidosis is crucial for improving patient management and outcomes. Identifying gender and race disparities highlights the need for targeted interventions to reduce these disparities. The nationwide trend analysis sheds light on the changing burden of MACCE among elderly patients with amyloidosis and gives us insights into critical needs in the healthcare system, disparities, resource allocation, and guides healthcare policies.

Methods: Utilizing National Inpatient Sample (NIS) 2016-2020 datasets, weighted data, and hospitalizations with amyloidosis using ICD-10-CM codes were identified. To determine significant association, we used the Chi-Square Test. Mann-Whitney U test was used to compare differences between two independent groups. A multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. The primary outcomes of interest are rates and odds of MACCE including acute myocardial infarction, cardiac arrest, and stroke, with a particular focus on gender and racial disparities. Co-primary outcomes included nationwide trends in MACCE among patients admitted with amyloidosis.

Results: We identified 6,455,4385 elderly (aged ≥ 65 years) patient hospitalizations with amyloidosis out of which 14.7% (p&lt;0.001) had MACCE. The odds of MACCE in patients with amyloidosis are greater than without (OR = 1.72, 95% CI of 1.66 to 1.78, p&lt;0.001). Both genders with amyloidosis had higher MACCE, however, females with amyloidosis showed higher rates of MACCE (14.9%, P&lt;0.001) vs males with amyloidosis (14.6%, p&lt;0.001). We utilized a multivariable logistic regression model that adjusted for patient and hospital-level confounders such as age in years at admission, sex, race, payer type, median household income, hypertension, diabetes with and without chronic complications, hyperlipidemia, obesity, severe renal failure, hypothyroid, and other thyroid disorders, etc., Furthermore, a linear trend in MACCE rates increasing across the years in both cohorts (i.e., with and without amyloidosis) was noticed. However, with amyloidosis, it is significantly higher and consistently increasing especially in Asian or Pacific Islanders without amyloidosis (11.6%) compared to those with amyloidosis (17.0%), p&lt;0.001]and Native Americans without amyloidosis (10.6%) compared to those with amyloidosis (22.2%, p&lt;0.001)].

Conclusion and Relevance: Linear trends in the prevalence of MACCE in individuals with Amyloidosis are significantly higher in all races and both genders. This trend was prominently higher in Asian or Pacific Islanders and Native Americans. Furthermore, a linear trend over the years is observed in MACCE rates in both cohorts (i.e., without and with amyloidosis) and was significantly higher in cohorts with amyloidosis. This study underscores the importance of tailored healthcare strategies to mitigate adverse cardiovascular and cerebrovascular outcomes in this vulnerable population. Additionally, the nationwide trend analysis provides insight into the evolving burden of MACCE among elderly patients with amyloidosis, informing healthcare policies and resource allocation.

Keywords: Major Cardiovascular and Cerebrovascular Events (MACCE), Elderly, Hospitalized, Gender Disparity, Racial Disparity, National Inpatient Sample