The Prevalence and in-House Mortality for Different Types of Heart Failure Among Sickle Cell Patients

Introduction

Cardiovascular complications with aging among sickle cell disease (SCD) patients are deemed to be important as SCD patients' survival is improving. However, the prevalence of heart failure according to the different types has yet to be documented. Also, the associated comorbidities and the impact on in-house mortality are largely unknown. Therefore, we aimed to investigate the prevalence of heart failure among sickle cell patients and evaluate in-house mortality according to each type.

Methods

All hospitalizations of adult sickle cell patients older than 18 in the US were selected from the National Inpatient Sample during 2016-2020. ICD-10 codes were used to identify all hospitalized patients with sickle cell disease and were dichotomized based on the presence of heart failure according to different types of heart failure. The type of heart failure was classified into ischemic vs. non-ischemic, Left-sided vs. Right-sided, acute vs. chronic, systolic vs. diastolic. Primary outcome was the prevalence of heart failure across different types among SCD patients. Secondary outcomes include associated comorbidities and in-hospital all-cause mortality analyzed among sickle cell patients with each type of heart failure.

Results

The number of adult SCD cases is 776,795. Among them, 65,960 cases were found to have heart failure (8.5%). SCD with heart failure were older (51.5 years vs 29.9 years, p<0.001), male predominant (40.2% vs 36.9%, p<0.001), had higher comorbidities with approximately 85% (n = 58,616) having Charlson comorbidities category 2 or above compared to only 15% (n = 106,625) among those without heart failure. Pulmonary hypertension was present among 70.2% of right-sided heart failure; however, less than 20% among other types of heart failure. All-cause mortality among SCD was higher among those with heart failure than those without heart failure (adjusted OR 1.28 [1.10 - 1.49], p=0.001). All types of heart failure were also associated with increased mortality; however, when adjusted for age, gender, and comorbidities, increased risk of all-cause mortality was found among right-sided heart failure (adjusted OR 5.83 [3.88 - 8.76], p<0.001), systolic heart failure, adjusted OR 1.46 [1.17 - 1.82], p=0.001) and acute heart failure exacerbation (adjusted OR 1.42 [1.14 - 1.76], p<0.001). Among patients with acute heart failure exacerbation, systolic heart failure (adjusted OR 1.89 [1.42 - 2.50], p<0.00) was associated with increased mortality, whereas diastolic heart failure did not.

Conclusion

Right-sided heart failure and systolic heart failure are associated with significantly higher all-cause mortality among hospitalized sickle cell patients. Acute exacerbation of systolic heart failure was also associated with higher all-cause mortality. Further studies are warranted to investigate risk factors for these types of heart failure to prevent higher inpatient all-cause mortality in patients with SCD.

No relevant conflicts of interest to declare.