S2355 Predictive Factors and Outcomes of Cardiac Complications in Patients With Hepatocellular Carcinoma: A National Inpatient Sample Study

Introduction: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the sixth most frequently diagnosed cancer worldwide, accounting for over 900,000 new cases annually. HCC patients frequently present with complex medical profiles that may predispose them to cardiovascular complications. However, large-scale epidemiologic data on the burden and predictors of cardiac events in this population are limited. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2017 to 2021, identifying adult hospitalizations with HCC. Cardiac complications including acute coronary syndrome (ACS), heart failure (HF), and cardiac dysrhythmias were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Multivariable logistic regression models were used to identify predictors of cardiac events and associated outcomes, adjusted for demographics, comorbidities, and hospital characteristics. Results: Among 439,811 HCC hospitalizations, 107,913 (24.5%) experienced a cardiac complication. Patients with cardiac complications were older (mean age 71.3 vs 64.7 years, P < 0.001), more likely to be man, and predominantly White (66.8% vs 57.7%, P < 0.001). They had higher prevalence of comorbid hypertension (78.3% vs 57.5%), diabetes (45.4% vs 34.4%), and dyslipidemia (39.8% vs 25.8%) (P < 0.001 for all). In adjusted analyses, advancing age (aOR per year: 1.06, P < 0.001), male sex (aOR: 0.91 for women, P < 0.001), and higher income quartiles were significant predictors of cardiac complications. Compared to Whites, Black (aOR: 0.81), Hispanic (aOR: 0.58), and Asian (aOR: 0.63) patients had lower odds of cardiac events (P < 0.001 for all). Medicaid (aOR: 0.38), private insurance (aOR: 0.40), and self-pay (aOR: 0.35) were associated with significantly lower odds compared to Medicare (P < 0.001). Urban-teaching hospitals had slightly lower odds than rural settings (aOR: 0.85, P < 0.001). Cardiac complications were independently associated with increased in-hospital mortality (aOR: 1.53, P < 0.001), ICU admission (aOR: 2.24, P < 0.001), prolonged length of stay (+1.71 days, P < 0.001), and higher total hospital charges (+$25,543, P < 0.001). Conclusion: Cardiac complications affect nearly 1 in 4 hospitalized patients with HCC and are associated with significant morbidity, resource utilization, and mortality. Patient demographics, comorbidity burden, and hospital characteristics influence risk. These findings underscore the need for integrated cardio-oncology strategies in managing HCC patients.