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Sunday Poster Session

Category: GI Bleeding

P0608 - Mortality Outcomes in Upper GI Bleeding and Heart Failure: A Nationwide Analysis

Sunday, October 22, 2023
3:30 PM - 7:00 PM PT
Location: Exhibit Hall
Has Audio
ACG Outstanding Poster Presenter
Enoch J. Abbey, MD, MPH1, Rahman Olusoji, MD1, George Wuni, MD2, Samuel K. Ayeh, MD, MPH3, Gerald Fletcher, MD, MBA4, Joan Culpepper-Morgan, MD, FACG2
1Harlem Hospital Center - NYCHHC, New York, NY; 2Harlem Hospital, New York, NY; 3MedStar Health, Baltimore, MD; 4Harlem Hospital Center, New York, NY

Introduction: The overlap between cardiac disease and upper gastrointestinal bleeding (UGIB) cannot be overemphasized, with many experts calling for a collaborative approach “cardiogastroenterology” to its management. Heart failure was designated as an emerging epidemic in 1997 with current estimates of 6.5 million Americans above the age of 20 years having heart failure. Though no solid evidence supports the broad-based use of anticoagulation in heart failure, their use is increased because of the prevalence of ischemic heart disease, atrial fibrillation and venous thromboembolism in this population. In this study we explore morbidity and mortality among heart failure patients admitted for UGIB.

Methods: This was a retrospective cohort study involving adults ≥65 years old with a diagnosis of heart failure and UGIB at presentation using the 2018-2020 Nationwide Inpatient Sample database. Demographic and clinical risk factors for UGIB outcome were assessed. Relationship to mortality as the major outcome was quantified using both univariable and multivariable logistic regression models.

Results: We identified 10,239,959 people who presented with UGIB. Of this group 9535 had variceal bleeding and 896 (9.4%) of this group died. The remaining group had non-variceal bleeding and 593,365 (5.8%) experienced mortality. Increasing age (1.03), male sex (1.15), large bed sized hospitals (1.13), urban teaching hospitals (1.05), Charlson's comorbidity score (1.31) and weekend admissions (1.06) were associated with increased odds of mortality in multivariable regression analysis (Table 1). Factors that were associated with reducing the odds ratio significantly for mortality included: EGD (0.59), therapeutic EGD (0.69) and early EGD (< 24 hours of admission) (0.59).

Discussion: Our study shows that in this select group of geriatric patients with heart failure and UGIB early intervention with therapeutic endoscopy is associated with less mortality and therefore should be the priority for treating this vulnerable group.

Covariate

Unadjusted Odds Ratio (95% CI)

p-value

Adjusted Odds Ratios (95% CI)

p-value

Female (%)

0.86 (0.85-0.87)

< 0.001

0.86 (0.85-0.87)

< 0.001

Race; 
White

Black

Hispanic

Asian or Pacific I.

Native American

Other

          

 

0.92 (0.90-0.94)

1.06 (1.03-1.10)

1.33 (1.27-1.38)

1.35 (1.25-1.46)

1.19 (1.14-1.25)

 

< 0.001

< 0.001

< 0.001

< 0.001

< 0.001

 

0.94 (0.92-0.97)

0.93 (0.90-0.96)

1.08 (1.03-1.13)

1.46 (1.35-1.58)

1.05 (1.00-1.09)

 

< 0.001

< 0.001

< 0.001

< 0.001

0.048

Mean Age (years)

1.02 (1.01-1.2)

< 0.001

1.03 (1.02-1.03)

< 0.001

Charlson’s Comorbidity Index;

2

≥3

 

 
1.10 (1.07-1.13)

1.36 (1.32-1.40)

 

 
< 0.001

< 0.001

 

 
1.10 (1.06-1.13)

1.31 (1.27-1.35)

 

 
< 0.001

< 0.001

Median Household Income;

$50,000-$64,999

$65,000-$85,999

≥$86,000

 

 
1.0  (0.98-1.02)

1.01  (0.99-1.03)

1.08 (1.05-1.10)

 

 
0.85

0.58

< 0.001

 

 
0.98 (0.96-0.99)

0.93 (0.91-0.95)

0.91 (0.88-0.93)

 

 
0.022

< 0.001

< 0.001

Hospital Region;

Northeast

Midwest

South

West

 

 

0.84 (0.81-0.86)

0.86 (0.84-0.89)

1.08 (1.04-1.11)

 

 

< 0.001

< 0.001

< 0.001

 

 

-

-

-

 

 

 

Hospital Bed Size

 Small

Medium

Large

 

 

1.13 (1.10-1.16)

1.23 (1.20-1.27)

 

 

< 0.001

< 0.001

 

 

1.06 (1.03-1.09)

1.13 (1.09-1.16)

 

 

< 0.001

< 0.001

Any EGD

0.70 (0.67-0.72)

< 0.001

0.59 (0.56-0.61)

< 0.001

Time to EGD

< 24 hours

 

0.60 (0.56-0.64)

 

< 0.001

 

0.59 (0.55-0.62)

 

< 0.001

Census Division of Hospital;

New England

Mid-Atlantic

East North Central

West North Central

South Atlantic

East South Central

West South Central

Mountain

Pacific

 

 

 
1.10 (1.04-1.16)

0.85 (0.81-0.90)

1.00 (0.95-1.06)

0.89 (0.85-0.93)

1.06 (0.99-1.12)

0.91 (0.86-0.96)

0.99 (0.93-1.05)

1.21 (1.16-1.27)

 

 

 
0.001

< 0.001

0.94

< 0.001

0.07

< 0.001

0.73

< 0.001

 

 

 
0.83 (0.78-0.88)

0.79 (0.75-0.83)

0.89 (0.84-0.95)

0.75 (0.71-0.80)

0.97 (0.91-1.03)

0.75 (0.70-0.79)

0.76 (0.71-0.80)

0.86 (0.81-0.91)

 

 

 
< 0.001

< 0.001

< 0.001

< 0.001

0.316

< 0.001

< 0.001

< 0.001

Teaching Status of Hospital;

Urban non-teaching

Urban teaching

 

 
1.09 (1.05-1.13)

1.26 (1.22-1.30)

 

 
< 0.001

< 0.001

 

 
0.93 (0.90-0.97)

1.05 (1.01-1.09)

 

 
< 0.001

0.005

Weekend

1.06 (1.5 -1.08)

< 0.001

1.06 (1.05-1.08)

< 0.001

EGD Intervention

0.82 (0.76-0.87)

< 0.001

0.69 (0.64-0.74)

< 0.001

EGD – esophagogastroduodenoscopy, Pacific I. - Pacific Islander,

Table: Unadjusted and Adjusted Regression Analyses for Mortality


Disclosures:
Enoch Abbey indicated no relevant financial relationships.
Rahman Olusoji indicated no relevant financial relationships.
George Wuni indicated no relevant financial relationships.
Samuel Ayeh indicated no relevant financial relationships.
Gerald Fletcher indicated no relevant financial relationships.
Joan Culpepper-Morgan indicated no relevant financial relationships.


Enoch J. Abbey, MD, MPH1, Rahman Olusoji, MD1, George Wuni, MD2, Samuel K. Ayeh, MD, MPH3, Gerald Fletcher, MD, MBA4, Joan Culpepper-Morgan, MD, FACG2. P0608 - Mortality Outcomes in Upper GI Bleeding and Heart Failure: A Nationwide Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.