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.