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Cardiovascular Events in Patients with Thyroid Storm
Zainulabedin Waqar1, Sindhu Avula2, Jay Shah1,2
1Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, USA.
Insights
Thyroid storm patients with cardiovascular events (CVEs) face significantly higher mortality and longer hospital stays. Conditions like obesity and alcohol abuse increase CVE risk in these patients.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- Thyroid storm presents with diverse symptoms, primarily cardiovascular (CV) manifestations like arrhythmia, heart failure, and ischemia.
- The frequency and patient characteristics of these CV events during thyroid storm are not well-documented.
Purpose of the Study:
- To determine the frequency and characteristics of cardiovascular occurrences in patients hospitalized for thyroid storm.
- To analyze the impact of these events on patient outcomes.
Main Methods:
- Retrospective analysis of adult hospitalizations for thyroid storm from January 2012 to September 2015 using the National Inpatient Sample database.
- Identification of hospitalizations using International Classification of Diseases (ICD)-9 codes.
- Analysis performed using Statistical Analysis System (SAS).
Main Results:
- Out of 6380 hospitalizations, 3895 had cardiovascular events (CVEs).
- Arrhythmia (N=3770) was most frequent, followed by acute heart failure (N=555) and ischemic events (N=150).
- In-hospital mortality (3.5% vs 0.2%) and length of stay (4 vs 3 days) were significantly higher in patients with CVEs.
Conclusions:
- Cardiovascular events in thyroid storm hospitalizations significantly increase mortality, length of stay, and costs.
- Obesity, alcohol abuse, chronic liver disease, and COPD are associated with higher likelihood of CVEs.
- Ischemic events and acute heart failure correlate with increased mortality; further research on arrhythmias is needed.
Context:
Thyroid storm can present as a multitude of symptoms, the most significant being cardiovascular (CV). It is associated with various manifestations such as cardiac arrhythmia, heart failure, and ischemia. However, the frequencies of events and characteristics associated with patients that experience these events are not known.
Methods:
Study cohort was derived from the National Inpatient Sample database from January 2012 to September 2015. Total hospitalizations of thyroid storm were identified using appropriate ICD-9 diagnostic codes. The analysis was performed using SAS.
Objective:
To better understand the frequency and characteristics CV occurrences associated with thyroid storm, through a retrospective analysis of thyroid storm hospital admissions.
Design:
The study cohort was derived from the National Inpatient Sample database from January 2012 to September 2015.
Setting:
Total hospitalizations of thyroid storm were identified using International Classification of Diseases (ICD)-9 diagnostic codes. The analysis was performed using Statistical Analysis System (SAS).
Results:
A total of 6380 adult hospitalizations were included in the final analysis, which includes 3895 hospitalizations with CV events (CEs). Most frequently associated CEs were arrhythmia (N = 3770) followed by acute heart failure (N = 555) and ischemic events (N = 150). Inpatient mortality was significantly higher in patients with CEs compared with those without CEs (3.5% vs 0.2%, P < 0.005). The median length of stay was also higher in patients with CEs compared with those without CEs (4 days vs 3 days, P < 0.0005). Atrial fibrillation was the most common arrhythmia type, followed by nonspecified tachycardia.
Conclusions:
In patients who were hospitalized due to thyroid storm and associated CEs significantly increased in-hospital mortality, length of stay, and cost. Patients with obesity, alcohol abuse, chronic liver disease, and COPD were more likely to have CEs. Patients with CV complications were at higher risk for mortality. In-hospital mortality increased with ischemic events and acute heart failure. Further evaluation is needed to further classify the type of arrhythmias and associated mortality.
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