Ikechukwu Eze, MD1, John Gharbin, MD1, Claudia Gyimah, MD1, Ihianle Osagie, MD2, Laiyemo Adeyinka, MD, MPH, FACG1 1Howard University Hospital, Washington, DC; 2Christus Highland Medical Center, Shreveport, LA
Introduction: Endoscopic procedures are commonly performed for diagnostic and therapeutic purposes in Acute Heart Failure (AHF) patients with gastrointestinal disorders. AHF patients are known to generally be at risk of shock. However, the clear risks of shock in AHF patients undergoing endoscopic procedure has not been established or explored. This study aimed to utilize the National Inpatient Sample to investigate the incidence and risk factors for shock in AHF patients undergoing endoscopic procedures.
Methods: This was a retrospective cohort study using the National Inpatient Sample Database from 2017 to 2020. Adult patients aged ≥ 18 years with a primary diagnosis of Acute Heart Failure who underwent non-elective endoscopic procedures using the International Classification of Diseases, Tenth Revision (ICD-10). For this analysis, endoscopic procedures refer to esophagoduodenoscopy (EGD) and colonoscopy. The primary outcome was the incidence of shock. Types of shock included in the analysis were undefined, cardiogenic, hypovolemic and hemorrhagic. Multivariate logistic regression analyses were performed to adjust for potential confounders and identify associated risk factors.
Results: A total of 3445 hospitalizations of patients with Acute Heart Failure who underwent endoscopic procedures were identified. Colonoscopy (78.4%) was performed more frequently than EGD (21.6%) in the study population. The mean age of AHF patients who underwent an endoscopic procedure was 68.5 years (p< 0.01). The incidence of shock was 17.6%. Patients with AHF who underwent endoscopic procedures had significantly higher risk of shock [OR 3.1, 95% CI 2.4 – 3.9, p< 0.01]. Independent risk factors for the development of shock in AHF patients (OR >1, p< 0.05) undergoing endoscopic procedures included older age, male sex, presence of Atrial Fibrillation, CKD and CLD. However, there was no statistically significant difference in the odds of shock between AHF patients undergoing EGD and colonoscopy (OR 0.6, 95% CI 0.34 - 1.32, p >0.05).
Discussion: This study suggests that patients with AHF who undergo endoscopic procedures may be at an increased risk of developing shock. This has implications for mortality, length of stay, and possibly, healthcare costs. Understanding the drivers of shock and poor clinical outcomes through further research in this patient population is imperative for better clinical decision making and patient care.
Disclosures:
Ikechukwu Eze indicated no relevant financial relationships.
John Gharbin indicated no relevant financial relationships.
Claudia Gyimah indicated no relevant financial relationships.
Ihianle Osagie indicated no relevant financial relationships.
Laiyemo Adeyinka indicated no relevant financial relationships.
Ikechukwu Eze, MD1, John Gharbin, MD1, Claudia Gyimah, MD1, Ihianle Osagie, MD2, Laiyemo Adeyinka, MD, MPH, FACG1. P1988 - Risk of Shock in Acute Heart Failure Patients Undergoing Endoscopic Procedures: A Nationwide Database Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
