S34 Impact of Heart Failure on Patients Hospitalized With Acute Pancreatitis: A Nationwide Analysis

Introduction: Acute pancreatitis is a serious condition, and its management is complicated in patients with heart failure (HF) due to challenges in fluid resuscitation. Limited data exist on how HF impacts outcomes in acute pancreatitis. This study evaluates the effect of HF on mortality and complications in hospitalized patients with acute pancreatitis. Methods: We conducted a retrospective observational study utilizing data from the Nationwide Inpatient Sample database (2016 to 2020) to identify adult hospitalizations with acute pancreatitis. We compared outcomes between patients with and without HF. The primary outcome was in-hospital mortality. Secondary outcomes were cardiac arrest, arrhythmias, acute respiratory and renal failure, and the need for life-saving interventions. Results: Among the 430,690 patients admitted with acute pancreatitis, 34,143 (7.9%) had HF as a comorbidity. Inpatient outcomes of these patients were compared to those who did not have HF. The group with HF was associated with higher in-hospital mortality (7.1% vs 1.7%, adjusted odds ratio [aOR]: 1.99; 95% CI: 1.86-2.10, P < 0.001); when adjusted for age, race, sex, and Charlson comorbidity index. Furthermore, they had a higher risk of acute kidney disease (32.2% vs 13.9%, aOR: 1.51; 95% CI: 1.47-1.55, P < 0.001), acute respiratory failure (7.4% vs 2.7%, aOR: 3.34; 95% CI: 3.24-3.45, P < 0.001) ventricular arrhythmias (4.7% vs 0.6%, aOR: 5.60; 95% CI: 5.20-6.03, P < 0.001), and cardiac arrest (2.4% vs 0.5%, aOR: 2.97; 95% CI: 2.71-3.25, P < 0.001). They also required higher life-saving treatments like dialysis (11.1% vs 2.1%, aOR: 3.18, 95% CI: 3.04-3.33, P < 0.001), pressors (3.0% vs 0.7%, aOR: 2.87, 95% CI: 2.64-3.11, P < 0.001), blood transfusion (7.4% vs 2.7%, aOR: 1.60, 95% CI: 1.52-1.68, P < 0.001) and ventilator support (11.9% vs 3.3%, aOR: 2.87, 95% CI: 2.75-2.98, P < 0.001). Conclusion: This study shows that patients with HF admitted for acute pancreatitis face significantly worse outcomes than those without HF. They have a higher likelihood of in-hospital death and an increased risk of complications such as acute kidney injury, respiratory failure, arrhythmias, and the need for life-saving interventions. A possible reason for this is the difficulty in balancing aggressive fluid resuscitation, a key aspect of pancreatitis treatment, with the risk of worsening HF. These findings emphasize the need for tailored treatment approaches and close monitoring of patients with both conditions to improve their prognosis.