Dermatomyositis, Polymyositis Linked to Doubling in Risk of Mortality in Heart Failure Patients

Nirav Zalavadiya, MD, MPH
Credit: LinkedIn

Patients with heart failure who also have polymyositis or dermatomyositis had a near doubling risk of cardiogenic shock and more than doubling in risk of mortality compared to their counterparts without polymyositis or dermatomyositis, according to a new study.

Presented at the Congress of Clinical Rheumatology (CCR) East 2023 annual meeting, results of the study provide an overview of the differences in risk of adverse outcomes, including mortality, cardiogenic shock, need for mechanical ventilation, and more, for people with congestive heart failure based on presence of concomitant polymyositis or dermatomyositis.¹

“Polymyositis/Dermatomyositis increases the mortality by two-fold in CHF patients. It is also associated with increased cost and length of hospital stay, thus increases the burden on patients and the healthcare,” wrote investigators.¹

Few fields have been the beneficiaries of the level of advancement witnessed within heart failure in the past decade. However, despite the emergence of new classes of pharmacological therapy and advances in device management, pitfalls and hurdles in care, such as lack of uptake and titration of guideline-directed medical therapy, hinder optimized management of the condition.

The current study, which was led by Nirav Zalavadiya, MD, MPH, a resident physician at Detroit Medical Center, was launched with the intent of further exploring the impact of polymyositis or dermatomyositis, a pair of systemic autoimmune disorders, on risk of adverse outcomes in patients with congestive heart failure using the National Inpatient Sample (NIS).¹

According to the Healthcare Cost and Utilization project website, the NIS is the largest publicly available all-payer inpatient healthcare database designed to produce US regional and national estimates of inpatient utilization, access, cost, quality, and outcomes. The database contains data related to approximately 7 million hospital stays each year and, when weighted, is representative of approximately 35 million hospitalizations nationally.²

With a period of interest defined as January 2016-December 2019, the investigators search yielded a total study population of 4,815,134 patients admitted for congestive heart failure. Of these, 99.95% (n=4,812,899) did not have underlying polymyositis or dermatomyositis and 0.05% (n=2235) did have polymyositis or dermatomyositis. Those with polymyositis or dermatomyositis were younger (mean age, 66 vs 71; P <.001) and more likely to be female (70.69% vs 47.84%; P <.001) than their counterparts without polymyositis or dermatomyositis.¹

Upon analysis, results indicated those with congestive heart failure and polymyositis or dermatomyositis had an increased likelihood of mortality (4.47% vs 2.65%) relative to their counterparts without polymyositis or dermatomyositis (adjusted odds ratio [aOR], 2.01; P <.003). Further analysis indicated presence of polymyositis or dermatomyositis was associated with an increased incidence of cardiogenic shock (aOR, 1.83; P=.009), but rates of acute respiratory failure (aOR, 1.01; P=.92) and need for mechanical ventilation (aOR, 1.01; P=.96) were not statistically different between the study arms.¹

When examining resource utilization, investigators found presence of polymyositis or dermatomyositis was associated with an increased adjusted mean total hospitalization charge ($73,108 vs $54,060 [adjusted mean change, $14,275]; P =.04) and mean length of stay (7.3 vs 5.4 days [adjusted mean change in length of stay, 1.03 days]; P=.002) relative to those without polymyositis or dermatomyositis.¹

“Since there is no testing apart from the auxiliary examinations that is excellent in both sensitivity and specificity to determine cardiac complications in its early stages, it is vital to pay more attention to the cardiac examination in polymyositis/dermatomyositis,” investigators added.¹

References:

1. Zalavadiya N, Basida B, Majmundar M. Impact Of Polymyositis and Dermatomyositis in Patients Admitted with Congestive Heart Failure – An Insight from The National Database. Paper presented at: Paper presented at: Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting. Destin, FL. May 4 – 7, 2023.
2. Overview of the National (Nationwide) Inpatient Sample (NIS). Healthcare Cost and Utilization Project. https://hcup-us.ahrq.gov/nisoverview.jsp. Accessed May 6, 2023.