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Longitudinal data on the trends in systemic lupus erythematous (SLE) readmissions are limited. We aimed to study trends in 30-day readmissions of patients admitted for SLE flares and all SLE hospitalizations in the USA from 2010 to 2018.Data were obtained from the nationwide readmission database (NRD). We performed a retrospective 9-year longitudinal trend analysis using the 2010-2018 NRD databases. We searched for index hospitalizations of adult patients diagnosed with SLE using the International Classification of Diseases (ICD) codes. Elective and traumatic readmissions were excluded from the study. Multivariable logistic and linear regression analyses were used to calculate the adjusted p value trend for categorical and continuous outcomes, respectively.The 30-day readmissions following index admissions of all SLE patients and for SLE flares decreased from 15.6% in 2010 to 13.3% in 2018 (adjusted p trend 0.0001), and 20.3% in 2010 to 17.6% in 2018 (adjusted p trend = 0.009) respectively. Following SLE-flare admissions, hospital length of stay (LOS) decreased from 6.7 to 6 days (adjusted p trend = 0.045), while the proportion with a Charlson comorbidity index (CCI) score ≥ 3 increased from 42.2 to 54.4% (adjusted p trend 0.0001) during the study period. SLE and its organ involvement, sepsis, and infections were common reasons for 30-day readmissions.About 1 in 5 SLE-flare admissions resulted in a 30-day readmission. The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have decreased in the last decade. Although the readmission LOS was reduced, the CCI score increased over time. Key Points • The 30-day readmissions following index hospitalization for SLE flares and all SLE hospitalizations have reduced in the last decade although the CCI score increased over time. • SLE, its organ involvement, and infections are common reasons for readmission. • Infection control strategies, optimal management of SLE and its complications, and emphasis on an ideal transition of care are essential in reducing SLE readmissions.

There is a scarcity of national United States (US) data on emergency department (ED) utilization of patients with bipolar disorder (BD). This study aims to determine the most common reasons for ED visits of patients with BD, and baseline characteristics of patients who present due to BD.We obtained data from the Nationwide Emergency Department Sample (NEDS), the largest all-payer ED database in the US. Each ED visit in NEDS 2018, can have only 1 "principal" diagnosis, which is the main reason for hospitalization, and up to 34 "secondary" diagnoses. We extracted data for all ED visits with "any" diagnosis of BD, using the ICD-10 code. We highlighted the 5 most common "principal" diagnoses based on the organ system involved and the 10 most specific "principal" diagnoses for all ED visits by patients with "any" diagnosis of BD. We highlighted baseline characteristics of ED visits with a "principal" diagnosis of BD.A total of 2,200,197 ED visits for patients with BD in 2018. Mental disorders such as BD, suicidal ideations, anxiety disorders and injuries and poisoning were common reasons for presentation to the ED. Among these, 291,319 had BD as the principal diagnosis. These patients were more likely to come from lower-income households.Possibility of coding errors due to ICD coding, and absence of data on race and medication compliance.BD, suicidal ideation, and anxiety disorders were the most common specific psychiatric reasons for presentation to the ED among patients with BD.

Background: With increasing utilization of cannabis in the United States (US), clinicians may encounter more cases of Gastroparesis (GP) in coming years.Objective: The primary outcome was inpatient...

Psoriasis is a chronic inflammatory state associated with an increased risk of cardiometabolic diseases, stroke, and mortality. Although psoriasis increases the risk of ischemic stroke, whether outcomes, including mortality, are adversely affected is unknown. This study aims to compare inpatient mortality of patients admitted for ischemic stroke with and without psoriasis. The secondary outcome measures were hospital length of stay (LOS), total hospital charges, odds of receiving tissue plasminogen activator (TPA), and mechanical thrombectomy between both groups. Data were obtained from the National Inpatient Sample (NIS) 2016 and 2017 databases using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariable logistic and linear regression analysis were used accordingly to account for confounders of the outcomes. The combined 2016 and 2017 NIS database comprised over 71 million discharges. Of these, ischemic stroke accounted for 525,570 hospitalizations and 2425 (0.5%) had a concomitant diagnosis of psoriasis. Patients hospitalized for ischemic stroke with coexisting psoriasis did not have a difference in inpatient mortality (3.5% vs 5.5%; p=0.285) compared with those without psoriasis. However, psoriasis cohort had shorter LOS (5.0 vs 5.7 days; p=0.029) and lower total hospital charges ($60,471 vs $70,246; p=0.003) compared with the non-psoriasis cohort. The odds of receiving TPA and undergoing mechanical thrombectomy were not different in both groups. Inpatient mortality, odds of receiving TPA, and undergoing mechanical thrombectomy in patients who had an ischemic stroke with or without psoriasis were not different. However, patients with psoriasis had a significantly shorter LOS and lower hospital charges.

This study compares outcomes of patients admitted for atrial fibrillation (AF) with and without coexisting systemic lupus erythematosus (SLE). The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacologic cardioversion and electrical cardioversion were secondary outcomes of interest. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for adult hospitalizations with AF as principal diagnosis with and without SLE as secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 821,630 hospitalizations were for adult patients, who had a principal diagnosis of AF, out of which, 2645 (0.3%) had SLE as secondary diagnosis. Hospitalizations for AF with SLE had similar inpatient mortality (1.5% vs 0.91%, adjusted OR (AOR): 1.0, 95% CI 0.47 to 2.14, p=0.991), LOS (4.2 vs 3.4 days, p=0.525), total hospital charges ($51,351 vs $39,121, p=0.056), odds of undergoing pharmacologic cardioversion (0.38% vs 0.38%, AOR: 0.90, 95% CI 0.22 to 3.69, p=0.880) and electrical cardioversion (12.9% vs 17.5%, AOR 0.87, 95% CI 0.66 to 1.15, p=0.324) compared with those without SLE. However, SLE group had increased odds of undergoing ablation (6.8% vs 4.2%, AOR: 1.9, 95% CI 1.3 to 2.7, p

This study compares the odds of being admitted for inflammatory bowel disease (IBD) in patients with psoriasis compared with those without psoriasis alone. We also compared hospital outcomes of patients admitted primarily for IBD with and without a secondary diagnosis of psoriasis. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database to search for hospitalizations of interest using International Classification of Diseases, 10th Revision codes. Multivariate logistic regression model was used to calculate the adjusted OR (AOR) of IBD being the principal diagnosis for hospitalizations with and without a secondary diagnosis of psoriasis. Multivariate logistic and linear regression analyses were used accordingly to compare outcomes of hospitalizations for IBD with and without secondary diagnosis of psoriasis. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Hospitalizations with a secondary diagnosis of psoriasis have an AOR of 2.66 (95% CI 2.40 to 2.96, p

Objective This study aims to compare the outcomes of patients primarily admitted for acute coronary syndrome (ACS) with and without systemic sclerosis (SSc). The primary outcome was odds of inpatient mortality. Hospital length of stay, total hospital charges, rates of cardiovascular procedures, and treatments were secondary outcomes of interest. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations for adult patients with ACS (ST-segment elevation myocardial infarction [STEMI], non-ST-segment elevation myocardial infarction [NSTEMI], and unstable angina) as principal diagnosis with and without SSc as secondary diagnosis using International Classification of Diseases, Tenth Revision codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. There were 1,319,464 hospitalizations for adult patients with a principal International Classification of Diseases, Tenth Revision code for ACS. There were 1155 (0.09%) of these hospitalizations that had SSc. The adjusted odds ratios for inpatient mortality for ACS, STEMI, and NSTEMI hospitalizations with coexisting SSc compared with those without SSc were 2.02 (95% confidence interval [CI], 1.19-3.43; p = 0.009), 2.47 (95% CI, 1.05-5.79; p = 0.038), and 2.19 (95% CI, 1.14-4.23; p = 0.019), respectively. Conclusions Acute coronary syndrome hospitalizations with SSc have increased inpatient mortality compared with those without SSc. ST-segment elevation myocardial infarction and NSTEMI hospitalizations with SSc have increased inpatient mortality compared with STEMI and NSTEMI hospitalizations without SSc, respectively. Acute coronary syndrome hospitalizations with SSc have similar hospital length of stay, total hospital charges, rates of revascularization strategies (percutaneous coronary intervention, coronary artery bypass surgery, and thrombolytics), and other interventions (such as percutaneous external assist device and intra-aortic balloon pump) compared with those without SSc.

Purpose The aim of this study was to compare the outcomes of patients primarily admitted for atrial fibrillation (AFib) with and without a secondary diagnosis of systemic sclerosis (SSc). The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, and electrical cardioversion were secondary outcomes of interest. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for adult hospitalizations with AFib as principal diagnosis with and without SSc as secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Of 821,630 AFib hospitalizations, 750 (0.09%) had SSc. The adjusted odds ratio for inpatient mortality for AFib with coexisting SSc compared with without coexisting SSc was 3.3 (95% confidence interval, 1.27-8.52; p = 0.014). Atrial fibrillation with coexisting SSc hospitalizations had similar LOS (4.2 vs 3.4 days; p = 0.767), mean total hospital charges ($40,809 vs $39,158; p = 0.266), odds of undergoing ablation (2.7% vs 4.2%; p = 0.461), and electrical cardioversion (12.0% vs 17.5%; p = 0.316) compared with without coexisting SSc. Conclusions Patients admitted primarily for AFib with a secondary diagnosis of SSc have more than 3 times the odds of inpatient death compared with those without coexisting SSc. Hospital LOS, total hospital charges, likelihood of undergoing ablation, and electrical cardioversion were similar in both groups.

OBJECTIVES The aims of this study were to compare the outcomes of patients primarily admitted for ischemic stroke with and without a secondary diagnosis of RA. METHODS Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for hospitalizations for adult patients with ischemic stroke as principal diagnosis with and without RA as secondary diagnosis using International Classification of Diseases, 10th Revision codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of receiving tissue plasminogen activator, and mechanical thrombectomy were secondary outcomes of interest. Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders. RESULTS There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. Of 525,570 patients with ischemic stroke, 8670 (1.7%) had RA. Hospitalizations for ischemic stroke with RA had less inpatient mortality (4.7% vs. 5.5%; adjusted odds ratio, 0.66; 95% confidence interval, 0.52-0.85; p = 0.001), shorter LOS (5.1 vs 5.7 days, p < 0.0001), lower mean total hospital charges ($61,626 vs. $70,345, p < 0.0001), and less odds of undergoing mechanical thrombectomy (3.9% vs. 5.1%; adjusted odds ratio, 0.55; 95% confidence interval, 0.42-0.72; p < 0.0001) compared with those without RA. CONCLUSIONS Hospitalizations for ischemic stroke with RA had less inpatient mortality, shorter LOS, lower total hospital charges, and less likelihood of undergoing mechanical thrombectomy compared with those without RA. However, the odds of receiving tissue plasminogen activator were similar between both groups. Further studies to understand its mechanism would be helpful.

BACKGROUND/OBJECTIVE The aims of this study were to describe the rates and characteristics of nonelective 30-day readmission among adult patients hospitalized for acute gout and to assess predictors of readmission. METHODS We analyzed the 2017 Nationwide Readmission Database. Gout hospitalizations were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification code. Hospitalizations for adult patients were included. We excluded planned or elective readmissions. We utilized χ2 tests to compare baseline characteristics between readmissions and index hospitalizations. We used multivariate Cox regression to identify independent predictors of readmissions. RESULTS A total of 11,727 index adult hospitalizations with acute gout listed as the principal diagnosis were discharged alive and included. One thousand five hundred ninety-four (13.6%) readmissions occurred within 30 days. Acute gout was the most common reason for readmission. Readmissions had higher inpatient mortality (2.4% vs 0.1%, p < 0.0001), greater mean age (68.1 vs 67.0 years, p = 0.021), and longer hospital length of stay (5.9 vs 3.8 days, p < 0.0001) compared with index hospitalizations. Charlson Comorbidity Index scores of ≥2 (score 2: adjusted hazards ratio [AHR], 1.67; p = 0.001; score ≥3: AHR, 2.08; p < 0.0001), APR-DRG (All Patients Refined Diagnosis Related Groups) severity levels ≥2 (level 2: AHR, 1.43; p = 0.044; level 3: AHR, 1.83; p = 0.002; level 4: AHR, 2.38; p = 0.002), admission to metropolitan hospital (AHR, 1.83; p = 0.012), atrial fibrillation (AHR, 1.31; p = 0.004), and anemia (AHR, 1.30; p = 0.001) were significantly associated with 30-day readmissions. CONCLUSIONS Acute gout readmissions were associated with worse outcomes compared with index hospitalizations. Charlson Comorbidity Index scores ≥2, APR-DRG severity levels ≥2, admission to metropolitan hospital, atrial fibrillation, and anemia were significant predictors of readmission.

Introduction: With the increasing prevalence of diabetes mellitus (DM), there is an increasing burden of DM among pregnant women. Gestational DM (GDM), is a known complication of pregnancy which could affect the outcome for mother and child. This study looked into the burden of DM related gestations and readmissions. Methods: Data was obtained from the US National Readmissions Database for 2018, the largest database for readmissions in the US, which approximates yearly estimates. Index hospitalizations for DM complicating pregnancy and the postpartum period were obtained using ICD-10 codes. Hospitalizations less than 18 years of age and elective admissions were excluded. Outcomes included the rate of 30-day readmission (30DR) as well as identifying the commonest reasons for readmission among the studied cohort. Results: A total of 61,675 hospitalizations were included in the study as index admissions. Of these hospitalizations, 2,768 (4.50%) were readmitted within 30 days of discharge. The top reasons for readmission included severe pre-eclampsia, gestational DM, pre-existing DM type 1 in pregnancy, maternal care for scar from previous cesarean delivery, pre-existing DM type 2 in pregnancy and endometritis following delivery. Readmission was associated with increased healthcare utilization. Conclusion: Among pregnancies complicated by DM that led to hospitalization, a small proportion of patients get readmitted within 30 days for known complications of pregnancy. These could be associated with mortality, hence, research into factors and predictors of readmission in this population should be encouraged. Disclosure M. C. Aguilera: None. H. Shaka: None. C. D. Corpuz: None. M. Ramirez: None. S. T. Yap: None. P. O. Eseaton: None. M. Murthi: None.

Introduction: Psoriasis is known to increase the risk of type 1 diabetes mellites. This study aims to compare rates and outcomes of 30-day readmissions following admissions for type 1 diabetic ketoacidosis (T1DKA) in patients with and without psoriasis in the United States. Methods: We analyzed the 2018 National Readmission Database. We included index hospitalizations for all patients (aged≥18 years) with a principal diagnosis of T1DKA using ICD-10 codes. We further sub-stratified this group into those with and with a secondary diagnosis of psoriasis. Chi-square tests and regression analysis were used to compare 30-day readmission rates and readmission outcomes between both groups. We excluded elective and traumatic readmissions. Results: A total of 94,461 index hospitalizations for T1DKA, that were discharged alive, were included in the analysis. 357 (0.4%) of these, had co-existing psoriasis. 15,614 (16.5%) readmissions occurred within 30 days. Readmission rates were similar between psoriasis and non-psoriasis group (15.0% vs. 16.5%, p=0.663). The psoriasis group had a similar mean hospital length of stay (3.3 days vs. 2.9 days, p=0.077) and total hospital costs ($8,435 vs. $7,231, p=0.055) compared to the non-psoriasis group. Readmissions for T1DKA in psoriasis patients was associated with a total of 1,191 hospital days and $3,014,844 in-hospital costs. T1DKA without coma was the most common reason for readmission in both groups. Conclusion: Psoriasis patients admitted for T1DM have similar 30-day readmission rates and readmission outcomes compared to non-psoriasis patients admitted for TIDM. Disclosure E. Edigin: None. P. E. Ojemolon: None. H. Shaka: None. P. O. Eseaton: None. M. Almani: None. D. Jakhar: None. I. R. Asemota: None. E. Akuna: None.

The incidence of psoriasis (PsO) increased between 1970 to 2000 in the United States (U.S).1 Therapies for moderate-to-severe PsO and psoriatic arthritis (PsA) have experienced advances due to biologic agents' introduction in the early 2000s.2 We aim to study longitudinal trends of PsO hospitalizations in the last 2 decades in the U.S, following biologic agents' introduction. Data was obtained from the National Inpatient Sample (NIS) database, the largest hospitalization database in the U.S. NIS is a nationally representative stratified sample of 20% of all hospitalizations in the US. We performed a 21-year longitudinal trend analysis of NIS 1998-2018.

Diabetic ketoacidosis (DKA) is a known complication of patients with type 1 diabetes mellitus (T1DM), but less common in type 2 diabetes mellitus (T2DM). The aim of this study was to compare the outcomes of patients admitted to the hospital with DKA in T1DM versus T2DM. This was a population-based, retrospective, cohort study using data from the Nationwide Inpatient Sample. The group of patients hospitalized for DKA was divided based on a secondary diagnosis of either T1DM or T2DM. The primary outcome was inpatient mortality, and the secondary outcomes were rate of complications, length of hospital stay (LOS) and total hospital charge (THC). The inpatient mortality for DKA was 0.27% (650 patients). In T2DM, the adjusted OR (aOR) for mortality was 2.13 (95% CI 1.38 to 3.28, p=0.001) with adjusted increase in mean THC of $6035 (95% CI 4420 to 7652, p

Background Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. Viral organisms have been identified as the causal pathogen in approximately 20% of CAP. Nutritional status plays an important role in the response to pneumonia. This study aims to identify whether protein energy malnutrition (PEM) is an independent risk factor for mortality and morbidity in viral CAP. Materials and methods This was a retrospective cohort study involving adult hospitalizations for viral CAP in the United States using the Nationwide Inpatient Sample (NIS) database. This cohort was further divided based on the presence or absence of a secondary discharge diagnosis of PEM. The primary outcome was inpatient mortality. Secondary outcomes included the rate of mechanical ventilation among other complications. Results The in-hospital mortality for viral CAP was 2.22%. Patients with PEM had over two-fold high adjusted odds of inpatient mortality (aOR: 2.42, 95% CI: 1.746-3.351, p < 0.001) compared with patients without PEM. Patients with PEM had higher adjusted odds of having septic shock (aOR: 3.34, 95% CI: 2.158-5.160, p < 0.001). NSTEMI (aOR: 1.75, 95% CI: 1.163-2.621, p = 0.007), need for mechanical ventilation (aOR: 3.13, 95% CI: 2.448-4.006, p < 0.001), CVA (aOR: 3.49, 95% CI: 1.687-7.220, p = 0.001), DVT (aOR: 2.19, 95% CI: 1.453-3.295, p < 0.001), and PE (aOR: 2.24, 95% CI: 1.152-4.357, p = 0.017) relative to patients without PEM. Conclusion In conclusion, coexisting PEM is associated with a higher rate of in-hospital morbidity and mortality in patients with viral CAP. Early identification and treatment of nutritional deficiencies can lead to improved outcomes and reduced costs.

Background Obesity is now a recognized chronic comorbid condition which is highly prevalent in the United States. Obesity poses several health risks, affecting multiple organ systems. The cardiovascular system is particularly affected by obesity including its role in atherosclerotic disease and hence myocardial infarction (MI) from atheromatous plaque events. However, multiple population-based studies have shown mixed outcomes in obese patients who have acute MI. This study aimed to determine if obesity paradoxically improved outcomes in patients with acute myocardial infarction (AMI) as well as compare outcomes of mild to moderately obese patients and morbidly obese patients to non-obese patients. Materials and methods Data was obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study included adult patients with a principal discharge diagnosis of AMI. This group was divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment myocardial infarction (NSTEMI). Obese patients were subdivided into two groups: mild-moderate obesity and morbid obesity. Primary outcome compared inpatient mortality. Secondary outcomes included rate of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), composite revascularization, mean length of hospitalization, total hospital charges, and rates of complications. Results In patients with STEMI, mild to moderately obese patients had lower odds of mortality (aOR: 0.80, 95% CI: 0.715-0.906, p < 0.001) compared to non-obese patients. However, morbidly obese patients had higher odds of mortality (aOR: 1.26, 95% CI: 1.100-1.446, p < 0.001) compared to non-obese patients. Mild to moderately obese patients had higher odds of composite revascularization (aOR: 1.24, 95% CI: 1.158-1.334, p < 0.001), PCI (aOR: 1.08, 95% CI: 1.054-1.150, p = 0.014), and CABG (aOR: 1.46, 95% CI: 1.313-1.626, p < 0.001). Conclusion The degree of obesity affects outcome of patients with AMI. Cardiovascular interventions during hospitalizations for AMI also varied with degree of obesity. This may have affected the outcome, especially among morbidly obese patients.

Background Viral pneumonia is an important cause of respiratory morbidity and mortality. Cases of viral pneumonia are becoming increasingly more common as at-risk populations increase globally. We sought to highlight the racial distribution of hospitalized patients with viral pneumonia and compare their outcomes. Materials and methods Data were obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study involved adults who had a principal discharge diagnosis of viral pneumonia. The primary outcome analyzed was inpatient mortality. Secondary outcomes included the development of sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, non-ST segment elevation myocardial infarction (NSTEMI), acute kidney failure, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, need for mechanical ventilation, and use of vasopressors as well as mean length of hospitalization and mean total hospital charges. Results Blacks and Hispanics had lower inpatient mortality adjusted odds (aOR: 0.39, 95% CI = 0.229 - 0.662, p

Introduction: Amyloidosis is associated with conduction disturbances of the heart such as atrial fibrillation (AF). The outcomes of atrial fibrillation in patients with concomitant diagnosis of amyloidosis is not clearly established. This aim of this study is to compare outcomes of AF hospitalization with and without a secondary diagnosis of amyloidosis Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States (US). The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without a secondary diagnosis of amyloidosis (irrespective of specific organ involvement) using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were total hospital charge, rates of electrical cardioversion, pharmacologic cardioversion, and pacemaker implantation. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 715 (0.09%) had amyloidosis. AF hospitalizations with amyloidosis had higher inpatient mortality (AOR 4.56, CI 2.15-9.68, P Conclusion: Patients admitted primarily for AF with co-existing amyloidosis have increased inpatient mortality compared to those with amyloidosis. Rates of ablation, pacemaker implantation, electrical, and pharmacologic cardioversion were similar in both groups.

Introduction: Studies have shown that psoriasis increases the risk of atrial fibrillation (AF). However, it is unclear if co-existing psoriasis worsens outcomes in AF hospitalizations. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of psoriasis. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations for adult patients with AF as principal diagnosis with and without psoriasis as secondary diagnosis using ICD 10 codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacological, and electrical cardioversion were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to analyze the data. Results: There were over 71 million hospitalizations in the combined NIS 2016 and 2017 database. Out of 821,630 hospitalizations for AF, 4,490 (0.55%) had Psoriasis. Hospitalizations for AF with psoriasis had similar inpatient mortality [0.78% vs 0.92%, AOR 0.95, 95% CI (0.44-2.04), P=0.895], total hospital charge [$41,869 vs $39,145, P=0.572] and longer LOS [3.72 vs 3.37 days, P=0.023] compared to those without psoriasis. Odds of undergoing ablation [5.0% vs 4.2%, AOR 1.12, 95% CI (0.82-1.52), P=0.481], pharmacologic cardioversion [0.11% vs 0.38%, AOR 0.29, 95% CI (0.04-2.10), P=0.219] and electrical cardioversion [19.2% vs 17.5%, AOR 0.99, 95% CI (0.83-1.19), P=0.930] were similar in both groups. Conclusion: Hospitalizations for AF with psoriasis had longer LOS compared to those without psoriasis. AF hospitalizations with psoriasis however had similar inpatient mortality, total hospital charges, odds of undergoing ablation, pharmacologic and electrical cardioversion compared to those without psoriasis.

Introduction: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory autoimmune disease with effects on multiple organ systems and a wide range of clinical manifestations. Cardiovascular diseases from accelerated atherosclerosis are one of the major causes of mortality in SLE patients. This study aims to compare the outcomes of patients primarily admitted for Acute Coronary Syndrome (ACS) with and without a secondary diagnosis of SLE. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. This database is the largest collection of inpatient hospitalization data in the United States (U.S). The NIS was searched for hospitalizations for adult patients with ACS as principal diagnosis with and without SLE as secondary diagnosis using ICD 10 codes. The primary outcome was inpatient mortality. Secondary outcomes of interest are showed in Table 1. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to analyze the data. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Out of 1.3 million patients with ACS, 5,485 (0.42%) had SLE. The adjusted odds ratio (AOR) for inpatient mortality for ACS with co-existing SLE compared to those without SLE was 1.16 (95% CI 0.86-1.56, P=0.333). Hospitalizations for ACS with co-existing SLE had a decrease in adjusted mean total hospital charge of $5,164 compared to those without SLE (95% CI - {10,202-126}, P=0.045). Conclusions: Patients admitted primarily for ACS with a secondary diagnosis of SLE had less total hospital charges, but similar inpatient mortality, LOS, revascularization strategies, rates of IABP and PEAD placement compared to those without SLE. Though SLE is known to increase the risk of cardiovascular diseases, SLE does not negatively impact outcomes in patients primarily admitted for ACS based on U.S. national hospital billing data.

Introduction: Various forms of protein energy malnutrition (PEM) has been shown to affect different heart pathologies through its underlying pathogenesis of unabating chronic inflammation. The effect of PEM on atrial fibrillation (AF) is unclear. Our study sought to estimate the impact of PEM on clinical outcomes of hospitalizations for AF using a national database Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without PEM as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS) and total hospital charge. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 3% had PEM. Hospitalization for AF with PEM had a statistically significant increase in mortality (5.2% vs 0.8%, AOR 2.33, 95% CI 1.96 - 2.78, P Conclusion: In conclusion, PEM resulted in increased mortality, LOS and total hospital charge in patients hospitalized with AF. Nutritional rehabilitation in patients with PEM and concomittant AF may be needed to improve outcomes.

Introduction: Systemic Lupus Erythematosus (SLE) is known to increase the risk of atrial fibrillation (AF), however it is unclear if SLE worsens outcomes in patients admitted for AF. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of SLE. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations with AF as principal diagnosis with and without SLE as secondary diagnosis using ICD-10 codes. Hospitalizations for adult patients from the above groups were identified. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacologic, and electrical cardioversion were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to analyze the data. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 821,630 hospitalizations were for adult patients, who had a principal ICD-10 code for AF. 2,645 (0.3%) of these hospitalizations have co-existing SLE. SLE group were younger (67 vs 71 years, P < 0.0001) and had more females (85% vs 51%, P < 0.0001). Hospitalizations for AF with SLE had similar inpatient mortality (1.5% vs 0.91%, AOR: 1.0, 95% CI 0.47-2.14, P=0.991), LOS ( 4.2 vs 3.4 days, P=0.525), total hospital charges ( $51,351vs $39,121, P=0.056), odds of undergoing pharmacologic cardioversion ( 0.38% vs 0.38%, AOR: 0.90, 95% CI 0.22-3.69, P=0.880) and electrical cardioversion (12.9% vs 17.5%, AOR 0.87, 95% CI 0.66-1.15, P=0.324) compared to those without SLE. Hospitalizations for AF with SLE had increased odds of undergoing ablation (6.8% vs 4.2%, AOR: 1.9, 95% CI 1.3-2.7, P Conclusions: Patients admitted primarily for AF with co-existing SLE had similar inpatient mortality, LOS, total hospital charges, likelihood of undergoing pharmacologic and electrical cardioversion compared to those without SLE. However, SLE group had more odds of undergoing ablation.

Introduction: Hyperthyroidism is a well-established risk factor for developing Atrial fibrillation (AF). The impact of hyperthyroidism in patients admitted for AF is unclear. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of hyperthyroidism. Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States (US). The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without hyperthyroidism as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS), rate of ablation and electrical cardioversion. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 1.8% had hyperthyroidism. Hospitalization for AF with hyperthyroidism had similar inpatient mortality (0.5% vs 0.9%, AOR 0.61, CI 0.36-1.04, P=0.069), longer LOS (3.6 vs 3.4 days, p Conclusion: Hospitalizations for AF with hyperthyroidism had similar inpatient mortality, decreased LOS and less rates of ablation and electrical cardioversion compared to those without hyperthyroidism. Although, hyperthyroidism increases the risk of AF, hyperthyroidism does not negatively impact outcomes of patients admitted for AF based on US national hospital billing database.

Objectives This study aimed to compare the outcomes of patients primarily admitted for atrial fibrillation (AF) with and without a secondary diagnosis of rheumatoid arthritis (RA). The primary outcome of interest was inpatient mortality. Hospital length of stay (LOS), total hospital charges, and odds of undergoing ablation and pharmacologic cardioversion were the secondary outcomes of interest. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 databases. The NIS is the largest hospitalization database in the United States (US). The NIS was searched for hospitalizations for adult patients with AF as principal diagnosis with and without RA as secondary diagnosis using the International Classification of Diseases, 10th Revision (ICD-10) codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,630 AF hospitalizations, 17,020 (2.1%) had RA. Hospitalizations for AF with RA had 0.18 days' decrease in adjusted mean LOS (p=0.014), and lower total hospital charges ($38,432 vs $39,175, p=0.018) compared to those without RA. AF hospitalizations with RA had similar inpatient mortality [1.1% vs 0.91%, adjusted odds ratio (AOR): 0.90, 95% CI: 0.63-1.27, p=0.540] and odds of undergoing ablation (3.5% vs 4.2%, AOR: 1.1, 95% CI: 0.87-1.30, p=0.549) and pharmacologic cardioversion (0.38% vs 0.38%, AOR: 1.00, 95% CI: 0.53-1.89, p=0.988) compared to those without RA. Conclusions Patients admitted for AF with coexisting RA were found to have lesser adjusted mean LOS and lower total hospital charges compared to those without RA. However, inpatient mortality and the odds of undergoing ablation and pharmacologic cardioversion were similar between both groups.

The aims of this study were to compare the outcomes of patients primarily admitted for ischemic stroke with and without a secondary diagnosis of RA.Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for hospitalizations for adult patients with ischemic stroke as principal diagnosis with and without RA as secondary diagnosis using International Classification of Diseases, 10th Revision codes. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of receiving tissue plasminogen activator, and mechanical thrombectomy were secondary outcomes of interest. Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders.There were more than 71 million discharges included in the combined 2016 and 2017 NIS database. Of 525,570 patients with ischemic stroke, 8670 (1.7%) had RA. Hospitalizations for ischemic stroke with RA had less inpatient mortality (4.7% vs. 5.5%; adjusted odds ratio, 0.66; 95% confidence interval, 0.52-0.85; p = 0.001), shorter LOS (5.1 vs 5.7 days, p0.0001), lower mean total hospital charges ($61,626 vs. $70,345, p0.0001), and less odds of undergoing mechanical thrombectomy (3.9% vs. 5.1%; adjusted odds ratio, 0.55; 95% confidence interval, 0.42-0.72; p0.0001) compared with those without RA.Hospitalizations for ischemic stroke with RA had less inpatient mortality, shorter LOS, lower total hospital charges, and less likelihood of undergoing mechanical thrombectomy compared with those without RA. However, the odds of receiving tissue plasminogen activator were similar between both groups. Further studies to understand its mechanism would be helpful.

Objectives: This study aims to compare the outcomes of patients admitted primarily for acute coronary syndrome (ACS) with and without a secondary diagnosis of rheumatoid arthritis (RA). Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations of adult patients with ACS as principal diagnoses, with and without RA as a secondary diagnosis. The primary outcome was inpatient mortality. Secondary outcomes were hospitalization characteristics and cardiovascular therapies. Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Out of 1.3 million patients with ACS, 22,615 (1.7%) had RA. RA group was older (70.4 vs 66.8 years, P

Introduction Systemic sclerosis (SSc) is known to increase the risk of ischemic stroke and other cerebrovascular events. It is, however, unclear if SSc negatively impacts the outcomes of ischemic stroke hospitalizations. This study aims to compare the outcomes of patients primarily admitted for ischemic stroke with and without a secondary diagnosis of SSc. Methods Data were extracted from the National Inpatient Sample (NIS) 2016 and 2017 database. NIS is the largest hospitalization database in the United States. We searched the database for hospitalizations of adult patients admitted with a principal diagnosis of ischemic stroke, with and without SSc as the secondary diagnosis using International Classification of Diseases, Tenth Revision (ICD-10) codes. The primary outcome was inpatient mortality, and secondary outcomes were hospital length of stay (LOS), total hospital charge, odds of undergoing mechanical thrombectomy, and receiving tissue plasminogen activator (TPA). Multivariate logistic and linear regression analysis was used to adjust for confounders. Results Over 71 million discharges were included in the NIS database for the years 2016 and 2017. Out of 525,570 hospitalizations for ischemic stroke, 410 (0.08%) had SSc. Hospitalizations for ischemic stroke with SSc had similar inpatient mortality (6.10% vs 5.53%, adjusted OR 0.66, 95% CI (0.20-2.17); p=0.492), length of stay (LOS) (5.9 vs 5.7 days; p=0.583), and total hospital charge ($74,958 vs $70,197; p=0.700) compared to those without SSc. Odds of receiving TPA (9.76% vs 9.29%, AOR 1.08, 95% CI (0.51-2.27), P=0.848) and undergoing mechanical thrombectomy (7.32% vs 5.06%, AOR 0.75, 95% CI (0.28-1.98), P=0.556) was similar between both groups. Conclusions Hospitalizations for ischemic stroke with SSc had similar inpatient mortality, LOS, total hospital charge, odds of receiving TPA, and mechanical thrombectomy compared to those without SSc.

Background Knee arthroplasty is one of the most common reasons for hospitalizations in the United States. Diabetes mellitus is thought to be associated with adverse perioperative outcomes. We sought to demonstrate the effect of comorbid diabetes on hospitalizations involving patients with knee osteoarthritis who had knee arthroplasty. Materials and methods Data was obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. ICD-10 codes were used to obtain a cohort of patient who were principally admitted for knee osteoarthritis who underwent knee arthroplasty. The patients were further divided according to diabetic status. The primary outcome compared inpatient mortality. Secondary outcomes included mean length of hospital stay, total hospital charges, presence of secondary diagnoses on discharge of acute kidney injury, surgical site infection, sepsis, thromboembolic events, non-ST segment elevation myocardial infarction (NSTEMI). Results Patients with diabetes mellitus had a lower adjusted odds ratio for mortality (aOR: 0.45 95% CI: 0.221 - 0.920, p = 0.029), with no significant difference in total hospital charges and length of hospital stay. Interestingly, patients with diabetes had lower odds of NSTEMI; 0.53 (95% CI: 0.369 - 0.750, p < 0.001) sepsis; 0.64 (95% CI: 0.449 - 0.924, p = 0.017) and DVT; 0.67 (95% CI: 0.546 - 0.822, p < 0.001). Conclusion Uncomplicated diabetes mellitus is not associated with adverse outcomes in patients hospitalized with knee osteoarthritis who had knee arthroplasty.

The COVID-19 pandemic has affected almost all areas of human endeavors. The impact of the pandemic on medical students’ education in the USA (US) has been well established in the literature [1–3]. ...

Introduction: Psoriasis is a chronic immune-mediated, genetic disease manifesting in the skin or joints or both. Studies have shown an association between psoriasis and metabolic syndrome [1]. However, there is a scarcity of studies on metabolic and endocrine co-morbidities of hospitalized psoriasis patients. This study aims to compare the prevalence of metabolic and endocrine co-morbidities in hospitalized psoriasis patients to hospitalized non-psoriasis patients. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations for adult patients aged 18 years or above with a principal or secondary diagnosis of psoriasis and those without any diagnosis of psoriasis. Chi-square test was used to compare the prevalence of common metabolic and endocrine comorbidities between psoriasis and non-psoriasis hospitalized patients. Co-morbidities were obtained from secondary diagnoses. We used ICD-10 codes to obtain psoriasis hospitalizations and co-morbidities. STATA, version 16 was used for analysis. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of this, 323,405 hospitalizations had a diagnosis of psoriasis. Psoriasis hospitalizations had a higher prevalence of dyslipidemia (41.8% vs 31.8%, p Conclusion: Hospitalized psoriasis patients have a higher prevalence of dyslipidemia, hypothyroidism, hyperthyroidism, type 2 diabetes mellitus, obesity and non-alcoholic fatty liver disease compared to non-psoriasis hospitalized patients. Endocrinology consultation during hospitalization will be helpful in managing these comorbidities in psoriasis patients. References 1. Gisondi P, Fostini AC, Fossà I, Girolomoni G, Targher G. Psoriasis and the metabolic syndrome. Clin Dermatol. 2018;36(1):21–28. doi:10.1016/j.clindermatol.2017.09.005