Trends in In-Hospital Mortality in Patients Admitted With Cardiovascular Diseases in the United States With Demographics and Risk Factors of All Cardiovascular In-Hospital Mortality: Analysis of the 2021 National Inpatient Sample Database

Introduction and background Cardiovascular diseases (CVDs) encompass a range of disorders involving coronary artery diseases, valvular heart diseases, myocardial diseases, pericardial diseases, hypertensive heart diseases, heart failure (HF), and pulmonary artery diseases. Given the high prevalence of CVDs, understanding both overall and in-hospital mortality rates from these diseases is crucial. Unsurprisingly, most research, procedures, and new pharmacological interventions aim to reduce these rates. No recent studies have comprehensively detailed in-hospital mortality rates, demographics, and risk factors for all CVDs combined. Yet, in-hospital mortality rates due to CVD significantly impact patients' families and healthcare teams and serve as a critical measure of healthcare system development and effectiveness. Therefore, analyzing in-hospital mortality rates is essential for filling the gap in the recent comprehensive analysis of in-hospital mortality rates, demographics, and risk factors of all CVDs. Method The study used data from the National Inpatient Sample and the Nationwide Inpatient Sample (NIS) Databases of 2021 and HCUP tools. The NIS database extrapolates national estimates based on a stratified sample of 20% of US hospital discharges. Results were expressed as probability and relative risk using the t-test, with a P-value <0.05 being statistically significant. Statistical analyses were done using Stata statistical software version 18 (StataCorp LLC, College Station, TX, US). Results This study included 6,666,752 hospital admissions in the United States. Of these, 2,337,589 patients were admitted with CVDs and related symptoms, with 70,552 deaths occurring during hospitalization, resulting in an in-hospital mortality rate of 3.01% due to CVDs. Our study showed all CVD-induced in-hospital mortality combined was found to have a higher association with diabetes but a lower association with hypertension, hyperlipidemia, alcohol, and smoking. Conclusion The highest rates of cardiovascular disease in-hospital mortality are cardiac arrest, rupture of the cardiac wall as a complication of acute myocardial infarction, cardiogenic shock, rupture of papillary muscle as a complication of acute myocardial infarction, and rupture of chorda tendinea as a complication of acute myocardial infarction. The most common causes of CVD in-hospital mortality are non-ST-elevation myocardial infarction (NSTEMI) (19.20%), ST-elevation myocardial infarction (STEMI) (17.80%), cardiac arrest (15.10%), hypertensive heart disease with heart failure (12.50%), ventricular fibrillation (4.70%), ventricular tachycardia (3.30%), and aortic stenosis (2.10%). The most common risk factors for CVD in-hospital mortality are age, male gender, and diabetes. Proper diabetes control and management might be the highest preventive measure for all CVD-induced in-hospital mortality.