S219 Impact of Heart Failure Subtypes on Clinical Outcomes in Acute Pancreatitis: A Nationwide Inpatient Analysis

Introduction: Heart failure (HF) is a common comorbidity in patients hospitalized with acute pancreatitis (AP), yet its influence on inpatient outcomes remains understudied, particularly across HF subtypes. Given the rising burden of both HF and AP, understanding their interplay is critical for risk stratification and resource utilization. Methods: We conducted a retrospective cohort study using 2018 to 2022 National Inpatient Sample. Adults (≥18 years) hospitalized with principal diagnosis of AP were included. HF was identified using ICD-10 codes and categorized into HFrEF, HFpEF and Combined systolic and diastolic HF (comHF). We aimed to determine the prevalence of HF subtypes and evaluate their impact on inpatient mortality, acute kidney injury (AKI), venous thromboembolism (VTE), sepsis, vasopressor use, acute respiratory failure (ARF) and mechanical ventilation (MV). Survey-weighted logistic regression models were used to estimate adjusted odds ratios (AOR) controlling for age, sex, race, comorbidity burden (Elixhauser index). Results: Among 1,309,324 weighted hospitalizations for AP, approximately 82,275 (6.2%) had concurrent HF. Of these, 22,300 had HFrEF, 32,235 had HFpEF and 6980 had comHF. In AP with HF cohort, mean age was 71 years (-25 years, P < 0.001), men about 52.7% and higher Elixhauser scores (98% vs 60%, P < 0.001). Most of them were White (64.3%), followed by Black (23.6%), and Hispanic (7.8%). Overall in-hospital mortality was 0.6% for AP and it was significant in HF patients unadjusted (OR 4.5, P < 0.001) and in adjusted with HFrEF (AOR 4.6, P < 0.001), HFpEF (AOR 4.2, P < 0.001) and comHF (AOR 7.5, P < 0.001). HF patients had significantly increased hospital charges and length of stay unadjusted. HF increased the risk of AKI (28.2% vs 11.5%, P < 0.001), VTE (1% vs 0.5%, P < 0.001), sepsis (3.3% vs 1.3%, P < 0.001), vasopressor use (0.9% vs 0.3%, P < 0.001), ARF (9.3% vs 2.7%, P < 0.001) and MV (3% vs 1%, P < 0.001) in unadjusted model. HFrEF, HFpEF, comHF, higher Elixhauser score, and male sex are independent risk factors for all studied complications. Conclusion: HF was associated with increased mortality, length of stay, costs, AKI, VTE, sepsis, vasopressor use, ARF, and MV. Importantly, HFrEF, HFpEF, comHF, male sex and higher Elixhauser score emerged as independent predictors of poor outcomes. These findings highlight the need for tailored care and vigilance in AP patients with HF to reduce complications, mortality and resource utilization.