Congestive Heart Failure and Arrhythmias Among Hospitalized Patients With Carcinoid Syndrome

Introduction Carcinoid syndrome (CS) represents the most common functional syndrome in patients with neuroendocrine tumors which may be in an advanced tumor state. The pathophysiology of congestive heart failure (CHF) and arrhythmia in CS is poorly understood; however, chronic exposure to excessive circulating serotonin is considered one of the most important factors contributing to increased morbidity and mortality in this population. Despite recognition, international consensus guidelines specifically addressing the diagnosis and management of CHF and arrhythmia in CS are lacking. This study focused on hospitalized patients once they represent more severe disease states requiring intensive management, thereby providing a clearer understanding of factors influencing adverse clinical outcomes.  Methods This retrospective cohort study utilized the Healthcare Cost and Utilization Project National Inpatient Sample to identify predictors of congestive heart failure and arrhythmia in hospitalized CS patients from 2016 to 2018.  Results Initially, a total of 1,859 patients were included. After stratification, 606 patients had CHF and arrhythmia diagnosis with variables analyzed using multivariate logistic regression. Among 606 patients, 360 had CHF with advanced age, male sex, non-Hispanic Black race, Medicare insurance, and prolonged hospital stays, all of which were identified as significant predictors. Similarly, 246 patients diagnosed with arrhythmias were more prevalent in older and male patients and were associated with increased mortality and prolonged hospitalization. Conclusion These results highlight critical patient-related factors influencing mortality in CS patients with CHF and arrhythmia. Strategies aimed at early recognition, including clinical scoring systems, and biomarker assessment, could improve risk stratification and patient outcomes. Our findings underscore the importance of early risk stratification and targeted interventions to mitigate cardiac complications in CS patients. Additionally, incorporating our data into clinical practice has the potential to improve early recognition, promoting timely interventions for CS patients with CFH and arrhythmia. Developing consensus guidelines for managing CS-related cardiac complications, based on these insights, will further standardize care and improve patient outcomes.