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. 2024 Feb;47(2):e24235.
doi: 10.1002/clc.24235.

In-hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011-2019

Ian Ergui  1 , Joshua Salama  1 , Urvashi Hooda  2 , Bertrand Ebner  2 , Michael Dangl  1 , Louis Vincent  2 , Rhea Sancassani  3 , Rosario Colombo  2   3
Affiliations

In-hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011-2019

Ian Ergui et al. Clin Cardiol. 2024 Feb.

Abstract

Background: Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in-hospital outcomes and resource utilization in the setting of cardiogenic shock (CS).

Hypothesis: Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients.

Methods: The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD-9 and ICD-10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05).

Results: We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints.

Conclusions: These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under-diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long-term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.

Keywords: cardiogenic shock; homelessness; housing insecurity; mechanical circulatory support; unhoused.

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Conflict of interest statement

The author declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart detailing the selection of CS hospitalizations between 2011 and 2019 with and without homelessness. CS, cardiogenic shock.
Figure 2
Figure 2
Adjusted in‐hospital outcomes and events in housed versus unhoused patients with CS. Values < 1 indicate increased odds in housed patients. CS, cardiogenic shock.
See this image and copyright information in PMC

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