Impact of Direct Current Shock on Mortality and Outcomes in Patients with Pulmonary Embolism with Pre-Existing Atrial Fibrillation, Coronary Artery Disease, and Heart Failure: A National Inpatient Sample Analysis (2019-2021).

BACKGROUND

Pulmonary embolism (PE) remains a major cause of cardiovascular mortality, particularly in patients with underlying atrial fibrillation (AF), coronary artery disease (CAD), and heart failure (HF). The use of direct current (DC) shock in this complex population is not well studied and may pose risks.

OBJECTIVE

To evaluate the association between DC shock and in-hospital outcomes-including mortality, length of stay (LOS), and total hospital charges (TOTCHG)-in PE patients with pre-existing AF, CAD, and HF, using the National Inpatient Sample (NIS).

METHODS

A retrospective analysis was conducted using 2019-2021 NIS data. Adult patients hospitalized with PE and diagnoses of AF, CAD, and HF were included. Survey-weighted logistic and linear regressions were used to assess the association between DC shock and outcomes, adjusting for demographics, comorbidities, and hospital characteristics.

RESULTS

Among 1,152 unweighted (5.76 million weighted) patients, 14.7% received DC shock. DC shock was associated with a nearly fourfold increase in mortality (aOR = 3.90, 95% CI: 1.64-9.27, p = 0.002). DC shock recipients were younger and had lower comorbidity scores. Mortality disparities were observed among racial/ethnic minorities and older adults, with significant regional variation in DC shock use. Higher comorbidity scores were linked to increased hospital charges, but DC shock did not significantly impact LOS.

CONCLUSIONS

DC shock in PE patients with AF, CAD, and HF is associated with increased in-hospital mortality and reflects broader disparities in care by age, race, and geography. These findings highlight the need for risk-stratified treatment approaches and equity-focused care models in managing complex PE cases.