(18.12) Impact of hypoglycemia in Acute Coronary Syndrome outcomes: a national inpatient sample analysis

Hypoglycemia, while commonly observed in patients with diabetes mellitus, is an infrequent yet clinically significant occurrence in both outpatient and inpatient settings. Acute coronary syndrome (ACS), encompassing ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction, and unstable angina, continues to impose substantial healthcare burdens in the United States. Despite its prevalence, there is a paucity of research exploring the impact of hypoglycemia on ACS outcomes. This study aims to investigate the effects of hypoglycemia on mortality, length of stay, overall cost, and burden of medical care in patients with ACS.

Methods:

Using the National Inpatient Sample (NIS) for the years 2017 through 2020, we conducted a retrospective cohort study of adult patients (age >18) with a primary diagnosis of ACS. Disease and outcome codes were selected using the International Classification of Diseases (ICD-10). Statistical analysis was performed using STATA. Multivariate regression analysis was used to adjust for potential variables and calculate the adjusted odds ratio (aOR). Continuous variables were compared with the student t-test, while proportions were assessed using the Fisher exact test.  Mortality was the primary outcome of the study, with secondary outcomes encompassing length of stay (LOS), total hospitalization costs, septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA). Mortality rates, LOS, and overall hospitalization costs in the patients were calculated in patients with ACS with or without a diagnosis of hypoglycemia from 2017 to 2020.

Results:

Among 3,149,255 ACS diagnosed patients (age >18 years), 19,065 had hypoglycemia. Patients with hypoglycemia exhibited elevated rates of mortality (aOR=4.2, 23.8% vs.7.3%, p< 0.001), increased mean LOS (adjusted mean difference = 2.3, 8.5 vs.5.6 days, p< 0.001), and higher total hospitalization charges (adjusted mean difference = $138,168 vs. $107,083, p< 0.001) compared to the patients without hypoglycemia. Additionally, patients with hypoglycemia demonstrated significant rates of adverse outcomes, including septic shock, ARF, mechanical ventilation, ARDS, AKI, and CVA, compared to those without hypoglycemia. There was no significant difference in rates of pulmonary edema between the two groups. Trends over the study period indicated an increase in mortality and total cost of hospitalization for patients with hypoglycemia.

Discussion/Conclusion:

Our study suggests that the presence of hypoglycemia in ACS patients amplifies the healthcare burden, manifesting in increased mortality rates, extended hospital stays, heightened total hospitalization costs, and a greater incidence of adverse outcomes.  These findings underscore the necessity of meticulous blood glucose monitoring for inpatients, irrespective of diabetic status, to mitigate complications and enhance overall hospital outcomes.