The impact of pulmonary hypertension and comorbidities on in-hospital mortality in hypertrophic obstructive cardiomyopathy: A nationwide analysis from 2016 to 2021.

BACKGROUND

Hypertrophic obstructive cardiomyopathy (HOCM) may be complicated by pulmonary hypertension (PH).

OBJECTIVES

We aimed to evaluate the impact of PH and associated comorbidities on in-hospital mortality in patients with HOCM.

METHODS

We used the National Inpatient Sample from 2016 to 2021 to conduct this retrospective cross-sectional study. Patients with HOCM were stratified according to the presence of PH. Baseline demographics, comorbidities, and hospital-related characteristics were compared. Multivariate logistic regression was employed to identify predictors of in-hospital mortality in the entire cohort.

RESULTS

Out of 333,505 weighted patients with HOCM, 44,375 (13.3%) had PH. Patients with HOCM and PH were more likely to be female, older, and suffer from multiple comorbidities. The in-hospital mortality rate was higher in the HOCM and PH group (5.1% versus 3.3%, p < 0.001). PH was associated with in-hospital mortality in patients with HOCM (adjusted odds ratio [OR]: 1.20 [1.07-1.36], p = 0.003). The strongest positive predictors of in-hospital mortality included liver disease (OR: 3.44 [3.06-3.85]), age ≥65 years (OR: 2.91 [2.36-3.61]), and pneumonia (OR: 2.86 [2.57-3.19]) (all p < 0.001). Chronic heart failure was associated with an increased odds of in-hospital mortality (OR: 1.47 [1.33-1.63], p < 0.001). Prior percutaneous coronary intervention (OR: 0.68 [0.54-0.85], p < 0.001) or pacemaker/defibrillator (OR: 0.67 [0.59-0.77], p < 0.001) were associated with in-hospital survival.

CONCLUSIONS

PH in patients with HOCM was associated with increased in-hospital mortality. Prospective and longitudinal studies are needed to define the temporal relationship between PH and mortality. Vigilant management and tailored therapeutic strategies may mitigate adverse outcomes in patients with these cardiopulmonary conditions.