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Published on: May 25, 2017
Outcomes of Clostridioides difficile infection in acute heart failure hospitalizations: insights from the National
1Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA.
Insights
Patients with acute heart failure (HF) and Clostridioides difficile infection (CDI) experience significantly worse in-hospital outcomes, including higher mortality and longer stays. This combination increases healthcare costs and patient mortality risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Health Services Research
Background:
- Heart failure (HF) patients face elevated risks of hospital-acquired infections due to comorbidities and extended hospital stays.
- Clostridioides difficile infection (CDI) is a prevalent nosocomial infection in hospitalized individuals.
Purpose of the Study:
- To investigate the impact of concurrent Clostridioides difficile infection (CDI) on patients diagnosed with acute heart failure (HF).
- To analyze in-hospital outcomes, mortality, and healthcare costs in acute HF patients with and without CDI using the National Inpatient Sample (NIS) database.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016 to 2020.
- Included patients diagnosed with acute heart failure (HF), stratified by the presence of Clostridioides difficile infection (CDI).
- Performed adjusted odds ratio (aOR) calculations and propensity-matched analyses to compare outcomes.
Main Results:
- 0.56% of acute HF hospitalizations (3030 out of 536,595) also had CDI.
- Patients with acute HF and CDI showed significantly higher in-hospital mortality (aOR: 1.91), cardiac arrest (aOR: 1.66), and need for mechanical circulatory support (MCS) (aOR: 2.42).
- Propensity-matched analysis revealed higher mortality (13.71% vs 8.44%), septic shock (7.54% vs 3.33%), and MCS use (7.19% vs 3.68%) in HF patients with CDI. Longer hospital stays (14.45 vs 5.44 days) and increased costs ($186,225 vs $60,740) were observed.
Conclusions:
- Concomitant CDI in acute HF exacerbation is linked to poorer in-hospital outcomes and increased mortality.
- Patients with both acute HF and CDI experience significantly longer hospitalizations.
- The presence of CDI in acute HF patients leads to substantially greater financial costs for healthcare.
Background:
Heart failure (HF) patients are at a greater risk for nosocomial infections due to their higher prevalence of comorbidities, readmission rates, and prolonged hospital stays. Clostridioides difficile infection (CDI) remains a common nosocomial infection in hospitalized patients.
Aim:
To identify patients with a diagnosis of acute HF and stratified based on the presence of CDI, using the National Inpatient Sample (NIS) database from 2016 to 2020.
Methods:
Adjusted odds ratios (aOR) of in-hospital outcomes were calculated, and a propensity-matched analysis was performed.
Findings:
Of 536,595 acute HF hospitalizations in this timeframe, 3030 were also diagnosed with CDI (0.56%). Patients with acute HF and CDI had significantly higher in-hospital mortality (adjusted odds ratio: (aOR): 1.91), cardiac arrest (aOR: 1.66), and use of mechanical circulatory support (MCS) (aOR 2.42). In propensity-matched analysis, in-hospital mortality (13.71 vs 8.44%; P=0.005), septic shock (7.54 vs 3.33%; P=0.002), and use of MCS (7.19 vs 3.68%; P=0.009) were significantly higher in HF patients with CDI than without. Coexisting neurological disease (aOR: 3.74) and liver disease (aOR: 2.97) showed the strongest association as independent predictors of mortality. HF patients with CDI had longer hospital stays (14.45 ± 19.40 vs 5.44 ± 7.10 days; P<0.0001) and higher inflation-adjusted total hospital costs ($186,225 ± 376,485 vs $60,740 ± 153,992; P<0.001) compared to those without CDI.
Conclusion:
The occurrence of concomitant CDI in patients admitted with acute HF exacerbation is associated with worse in-hospital outcomes and deaths as well as longer hospitalizations and greater financial cost.
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