Hospital course in Patients with any Arrhythmia
Hospitalization course among patients with arrhythmias is summarized in
Table 2. HIV-related hospitalizations with arrhythmias had a
statistically significant longer average length of stay, compared to
without arrhythmias (5 days vs 4 days; P <0.0001). The median
cost of care was significantly higher in patients with arrhythmias
compared to all hospitalizations ($12210 versus $7665, IQR
$6248-$26167 in patients with arrhythmias and $4435-$14336 in all
hospitalizations; P<0.0001). The median length of stay and
cost of care in HIV-related hospitalizations with arrhythmias has mostly
remained unchanged over the years (P value of 0.0483 and 0.4019
respectively).
Markers of increased disease severity were more common among HIV-related
hospitalizations with arrhythmia compared to patients with no
arrhythmia. These include vasopressor use (1.3% versus 0.24%), cardiac
catheterization (7.17% versus 1.54%), cardiac arrests (4.09% versus
0.42%), CPR (3.4% versus 0.41%) and endotracheal intubation (12.75%
versus 3.7%).
All-cause in-hospital mortality was associated with the presence of any
cardiac arrhythmia. Patients with arrhythmias had an in-hospital
mortality rate of 9.6%, as opposed to a rate 2.84% found in patients
with no arrhythmia. However, the in-hospital mortality rate in patients
with any arrhythmia has decreased over the years from 12.35% in 2005 to
7.9% in 2014 (decrease of 43.8%; P<0.001 for trend). Among
the arrhythmias, the highest reduction in in-hospital mortality was
observed in patients with VT (decrease of 57.5%; P<0.0001 for
trend).
As anticipated, the highest in-hospital mortality was associated with
patients who had VF (46.11%), followed by VT (14.48%), SVT (8.73%)
and atrial flutter (7.51%). Despite being the most frequent arrhythmia
in HIV patients, AF was associated with the numerically lowest
in-hospital mortality (6.8%). Results for in-hospital mortality
throughout the years, stratified by arrhythmia type are summarized in
Table 3.