The Widow Maker: A National Inpatient Sample Study of Health Care Utilization Costs for Cardiovascular Complications Patients Diagnosed with Non-Hodgkin's Lymphoma from 2000-2014

Background:

Combination chemotherapy has improved the prognosis of DLBCL but has the potential for cardiovascular toxicity that can contribute to long-term morbidity and mortality. There is limited literature assessing the health care utilization costs for cardiovascular outcomes in patients diagnosed with non Hodgkin Lymphoma (NHL). We conducted this study to evaluate trends in hospital cost, length of stay, complication rates, and in-hospital mortality in adult patients diagnosed with non-Hodgkin lymphomas admitted for cardiovascular complications.

Methods:

We conducted a population-based study from the Nationwide Inpatient Sample (NIS). All adult admissions with a diagnosis of NHL from 2000-2014 were identified using ICD-9 codes. A priori outcome measures were left heart failure, atrial or ventricular arrhythmias, malignant or accelerated hypertension, hypertensive encephalopathy, and aortic dissection. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Logistic regression was used to compare rates of cardiovascular complications and mortality, cost, and length of stay between patients with NHL the general cardiovascular admissions (GCV), and between teaching and non-teaching hospitals.

Results:

Data were available for 9711761 hospitalized adults, of which 9711761 comprised the NHL group. The incidence of hospitalization for cardiovascular complications was 2.8 (OR = 2.78, 95% confidence interval [CI] 2.48+/-3.16) times higher in the NHL group than the general cardiovascular admissions (GCV) (58.7% versus 20.9%, P=0.005). Patients with Non Hodgkins lymphoma were 2.8 times more likely to be seen in the ED and admitted with cardiovascular complications than GCV patients (7,112,300 in the NHL group vs. 2,599,450 GCV group p< .005). Cardiovascular death was also twice as common in the NHL group (OR 2.2 95% confidence interval [CI] 1.9-3.6, 28.45% versus 19.54, P= 0.014). Risk factors for death included age ≥ 70 years (OR = 2.1, 95% confidence interval [CI] 1.4-3.0), male sex (OR=2.4, 95%CI 1.6-3.3) Caucasian race (OR=2.3, 95%CI 1.8-3.1), and admission at a teaching hospital (OR=1.67, 95%CI 1.2-2.4), average length of stay (4.8 days versus 2.3 days per 100 patients, p< 0.023) and total hospital cost ($960,554, 4206±45206 versus $479,167 ±19672, p = .002) were significantly higher in NHL patients than GCV patients. The leading cause of mortality was ventricular arrhythmias (88,350 death in the NHL group and 36,530 deaths in the GCV group). Rates for atrial arrhythmias, heart failure, acute myocardial infarction and accelerated hypertension were similar in both groups.

Conclusions: There is a high rate of cardiovascular morbidity in NHL patients and survivors, which contributes hospitalization, cost, and increased morbidity and mortality. This large population based study identifies a need for cardiovascular screening and risk reduction strategies after treatment for NHL.