TY - JOUR
T1 - Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve”
AU - Monlezun, Dominique J.
AU - Badalamenti, Andrew
AU - Javaid, Awad
AU - Marmagkiolis, Kostas
AU - Honan, Kevin
AU - Kim, Jin Wan
AU - Patel, Rishi
AU - Akhanti, Bindu
AU - Halperin, Dan
AU - Dasari, Arvind
AU - Koutroumpakis, Efstratios
AU - Kim, Peter
AU - Lopez-Mattei, Juan
AU - Yusuf, Syed Wamique
AU - Cilingiroglu, Mehmet
AU - Mamas, Mamas A.
AU - Gregoric, Igor
AU - Yao, James
AU - Hassan, Saamir
AU - Iliescu, Cezar
N1 - Publisher Copyright:
Copyright © 2023 Monlezun, Badalamenti, Javaid, Marmagkiolis, Honan, Kim, Patel, Akhanti, Halperin, Dasari, Koutroumpakis, Kim, Lopez-Mattei, Yusuf, Cilingiroglu, Mamas, Gregoric, Yao, Hassan and Iliescu.
PY - 2023/2/8
Y1 - 2023/2/8
N2 - Background: Carcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT). Methods: Machine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016–2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures. Results: Among 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012). Conclusion: This analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the “forgotten pulmonic valve” to improve outcomes and disparities in this understudied patient population.
AB - Background: Carcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT). Methods: Machine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016–2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures. Results: Among 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012). Conclusion: This analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the “forgotten pulmonic valve” to improve outcomes and disparities in this understudied patient population.
KW - artificial intelligence
KW - carcinoid
KW - cardio-oncology
KW - propensity score
KW - valvular disease
UR - http://www.scopus.com/inward/record.url?scp=85148650186&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85148650186&partnerID=8YFLogxK
U2 - 10.3389/fcvm.2022.1071138
DO - 10.3389/fcvm.2022.1071138
M3 - Article
C2 - 36843627
AN - SCOPUS:85148650186
SN - 2297-055X
VL - 9
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 1071138
ER -