Author + information
- Received August 21, 2018
- Revision received October 17, 2018
- Accepted October 17, 2018
- Published online January 3, 2019.
- Muhammad S. Panhwar, MDa,
- Ankur Kalra, MDb,∗ (, )
- Tanush Gupta, MDc,
- Dhaval Kolte, MD, PhDd,
- Sahil Khera, MD, MPHe,
- Deepak L. Bhatt, MD, MPHf and
- Mahazarin Ginwalla, MD, MSb
- aDepartment of Medicine, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- bDivision of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- cDivision of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
- dDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- eDivision of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York
- fDivision of Cardiovascular Medicine, Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Ankur Kalra, Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Mailstop LKS 5038, Cleveland, Ohio 44106.
Objectives This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF).
Background Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in HF patients.
Methods We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs.
Results Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40).
Conclusions Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.
Dr. Kalra consults for Medtronic and Philips. Dr. Bhatt is on advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; boards of directors of Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; is chair of American Heart Association Quality Oversight Committee; is on data monitoring committees for Baim Institute for Clinical Research, Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; receives honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research, Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute, Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees), Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), and VA CART Research and Publications Committee (Chair); receives research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, and The Medicines Company; receives royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); is site co-investigator for Biotronik, Boston Scientific, St. Jude Medical, and Svelte; is a trustee of American College of Cardiology; does unfunded research with FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda; and serves on the Steering Committee of INVESTED. Dr. Ginwalla is site principal investigator for GALACTIC-HF and PRIME-HF studies; and consults for Xact Labs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 21, 2018.
- Revision received October 17, 2018.
- Accepted October 17, 2018.
- 2018 American College of Cardiology Foundation
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