Pulmonary Hypertension Is Associated with Worse Outcomes in Patients Hospitalized for Sick Sinus Syndrome

Richard Orji; Favour Markson; Ayodeji Ilelaboye; Emeka Okoronkwo; Hafeez Shaka; Hakeem Ayinde; Tonye Teme

doi:10.19102/icrm.2023.14105

Pulmonary Hypertension Is Associated with Worse Outcomes in Patients Hospitalized for Sick Sinus Syndrome

J Innov Card Rhythm Manag. 2023 Oct 15;14(10):5622-5628. doi: 10.19102/icrm.2023.14105. eCollection 2023 Oct.

Authors

Richard Orji^{1

2

3}, Favour Markson⁴, Ayodeji Ilelaboye⁵, Emeka Okoronkwo⁶, Hafeez Shaka⁷, Hakeem Ayinde⁸, Tonye Teme⁹

Affiliations

¹ Department of Medicine, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA.
² Department of Medicine, Northwestern Medicine McHenry Hospital, McHenry, IL, USA.
³ Department of Management, University of Massachusetts Amherst, Amherst, MA, USA.
⁴ Department of Medicine, Lincoln Medical Center, New York, NY, USA.
⁵ Department of Medicine, Lautech Teaching Hospital, Ogbomoso, Oyo, Nigeria.
⁶ Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.
⁷ Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
⁸ Division of Cardiology, Novant Health Heart & Vascular Institute Charlotte, Charlotte, NC, USA.
⁹ Division of Cardiology, Northwestern Medicine, McHenry Hospital, McHenry, IL, USA.

Abstract

Sick sinus syndrome (SSS) is a condition of the sinoatrial node that arises from a constellation of aberrant rhythms, resulting in reduced pacemaker activity and impulse transmission. According to the World Health Organization, pulmonary hypertension (PH) is defined by a mean pulmonary arterial pressure of >25 mmHg at rest, measured during right heart catheterization. It can result in right atrial remodeling, which may predispose the patient to sinus node dysfunction. This study sought to estimate the impact of PH on clinical outcomes of hospitalizations with SSS. The U.S. National Inpatient Sample database from 2016-2019 was searched for hospitalized adult patients with SSS as a principal diagnosis with and without PH as a secondary diagnosis using the International Classification of Diseases, Tenth Revision, codes. The primary outcome was inpatient mortality. The secondary outcomes were acute kidney injury (AKI), cardiogenic shock (CS), cardiac arrest, rates of pacemaker insertion, total hospital charges (THCs), and length of stay (LOS). Multivariate regression analysis was used to adjust for confounders. A total of 181,230 patients were admitted for SSS; 8.3% (14,990) had underlying PH. Compared to patients without PH, patients admitted with coexisting PH had a statistically significant increase in mortality (95% confidence interval, 1.21-2.32; P = .002), AKI (P < .001), CS (P = .004), THC (P = .037), and LOS (P < .001). In conclusion, patients admitted primarily for SSS with coexisting PH had a statistically significant increase in mortality, AKI, CS, THC, and LOS. Additional studies geared at identifying and addressing the underlying etiologies for PH in this population may be beneficial in the management of this patient group.

Keywords: Cardiac arrest; cardiogenic shock; pacemaker insertion; pulmonary hypertension; sick sinus syndrome.