Next Article in Journal
Screening and Treating Disordered Eating in Weight Loss Surgery: A Rapid Review of Current Practices and Future Directions
Previous Article in Journal
Effect of High-Fat Diet and Lactiplantibacillus plantarum 299v on the Gut Microbiome of Adolescent and Adult Rats
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Obesities
Volume 5
Issue 1
10.3390/obesities5010018
obesities-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Association of Malnutrition in Patients Admitted with Complete Heart Block: A Nationwide Analysis

by
Nahush Bansal
1,*,
Sonaal Singla
2,
Jasneet Kaur
3,
Nikita Sharma
4,
Feehaan Sultan
1 and
Shuhao Qiu
1
1
Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA
2
Department of Internal Medicine, University of California, Riverside, CA 92521, USA
3
Department of Internal Medicine, Nassau University Medical Center, New York, NY 11554, USA
4
Division of Cardiology, Dayanand Medical College, Ludhiana 141001, India
*
Author to whom correspondence should be addressed.
Obesities 2025, 5(1), 18; https://doi.org/10.3390/obesities5010018
Submission received: 10 February 2025 / Revised: 12 March 2025 / Accepted: 17 March 2025 / Published: 19 March 2025
Versions Notes

Abstract

:
Background: Complete heart block (CHB) is a cardiac conduction disorder that can be fatal if not treated promptly. Malnutrition has been shown to have a significant impact on various cardiac conditions. Aim: The objective was to determine if the nutritional status influences the outcomes in patients with CHB. Methods: A retrospective study was conducted using the United States Inpatient Sample database on patients admitted with complete heart block. Outcomes were compared between the patients with and without concomitant malnutrition. Results: The study included 37,480 patients with complete heart block, of whom 603 (1.61%) had malnutrition. Compared to patients without malnutrition, patients with malnutrition had higher adjusted in-hospital mortality rates (aOR 2.61; 95% CI 1.46–3.48), longer length of stay (LOS) (mean increase 2.23 days; p < 0.01), and higher hospital charges (mean increase USD 76,907.32; p < 0.01). The malnourished group also had significantly higher rates of cardiogenic shock (aOR 2.80; 95% CI 1.56–5.03; p < 0.01) and acute respiratory failure (aOR 2.65; 95% CI 1.67–4.22; p < 0.01). Patients with malnutrition had significantly lower rates of permanent pacemaker (aOR 0.57; 95% CI 0.38–0.86; p < 0.01) and longer delay to permanent pacemaker intervention (mean increase 1.38 days; p = 0.014). The impact on outcomes was worse in patients with severe malnutrition compared to those with mild to moderate malnutrition. Conclusions: Malnutrition is associated with significantly worse outcomes in CHB admissions, including higher mortality, resource utilization, complications, and lower and delayed pacemaker intervention. Individualized and timely nutritional interventions might potentially play a key role in improving outcomes in these patients.

1. Introduction

Complete heart block (CHB), also known as third-degree heart block, is a disease of cardiac conduction pathways characterized by total loss of atrial impulses to reach the ventricles [1]. This condition, with an incidence of approximately 0.02% to 0.04%, can be fatal if not treated promptly [1]. Etiologies for complete heart block can be diverse, including structural heart diseases, ischemic heart disease, medication toxicity, post-operative like after transcatheter aortic valve replacement (TAVR), electrolyte abnormalities, infectious causes like Lyme’s disease, and systemic diseases including sarcoidosis, amyloidosis, nodal ablation and fibrosis of the conduction system [2]. Treatment includes controlling the reversible factors, supportive care, trials with positive chronotropic medications, and temporary pacing options, with many patients eventually requiring permanent pacemaker implantation [1,3].
The World Health Organization (WHO) defines malnutrition as deficiencies or excesses in nutrient intake, imbalance of essential nutrients, or impaired nutrient utilization [4]. Although by this definition, malnourished individuals can be either under- or over-nourished, ‘malnutrition’ is often used synonymously with ‘undernutrition’, as in this article. Malnutrition has been shown to have drastic consequences in various cardiovascular diseases like acute coronary syndrome, heart failure, etc. [5,6,7,8]. Malnutrition is known to be associated with various cardiac arrhythmias [9]. It has been demonstrated to significantly impact the hospital outcomes in atrial fibrillation; however, the evidence for complete heart block is scarce [10]. We hypothesized that patients admitted with complete heart block and concurrent malnutrition are likely to have significantly worse outcomes, as opposed to patients without malnutrition.
This study evaluates the effect of malnutrition on outcomes, including mortality, length of stay (LOS), and total hospitalization charges in patients with complete heart block using the large National Inpatient Sample (NIS) database. The occurrence of complications, PPM implantation rates and time, and the differences in outcomes based on the severity of malnutrition were also assessed.

2. Materials and Methods

2.1. Study Design

This is a retrospective cohort study of adult patients hospitalized in 2020 across acute care hospitals in the United States. An analysis was conducted using the National Inpatient Sample (NIS), created by the Agency for Healthcare Research and Quality (AHRQ). It is the largest publicly available all-payer inpatient database, representing all nonfederal acute care hospitals nationwide. Hospitals are stratified according to ownership, control, bed size, teaching status, urban/rural location, and geographic region. A 20% probability sample of all hospitals within each stratum is then collected. All discharges from these hospitals are recorded and weighted to represent nationally. The 2020 NIS sampling frame includes data about all patients admitted between 1 January and 31 December 2020 from 49 statewide data organizations, covering 98 percent of the U.S. population, providing both hospital- and patient-level information. Since the NIS contains de-identified and anonymized data, this study was exempt from institutional review board (IRB) approval and informed consent requirements.

2.2. Participants

Patients were selected using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD10-CM) coding system. ICD10-CM codes for the principal diagnosis of complete heart block (I442) were identified. The inclusion criteria included all adult patients (aged ≥ 18 years) admitted with a primary diagnosis of complete heart block. Malnutrition was identified using ICD 10 codes E40–E46. We classified E42 (Marasmus) and E43 (unspecified severe protein-calorie malnutrition) as severe malnutrition, reflecting significant protein–energy deficiency with major clinical implications. The remaining codes (E40, E41, E44, E45, E46) were classified as mild to moderate malnutrition, as they represent less severe forms or specific nutrient deficiencies. This classification is consistent with ICD-10-CM coding guidelines and prior administrative database studies assessing malnutrition severity [11,12,13]. All the ICD10-CM codes used in this study for diagnosis and outcomes are listed in Appendix A Table A1. The primary outcome of the study was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges, occurrence of cardiogenic shock, cardiac arrest, and acute respiratory failure. The exposure of interest was the presence of malnutrition. Outcomes were also compared based on the degree of malnutrition, severe or mild to moderate malnutrition. Potential confounders that were adjusted using multivariate regression analysis included age in years, female sex, race (Caucasian, African American, Hispanic, Asian or Pacific Islander, Native American, and Other), median income in patients’ ZIP code, patient comorbidities, hospital location (rural or urban), geographic region (Northeast, Midwest, West, or South), hospital teaching status, hospital bed size and primary expected payer or insurance status. Adjusting for the comorbidities was performed using the Charlson Comorbidity Index (CCI), a commonly used and validated prognostic tool [14]. In addition to the CCI score, we independently adjusted for specific comorbidities relevant to our study population, including diabetes mellitus, hypertension, hyperlipidemia, chronic kidney disease, etc. Age, sex, race, socioeconomic status, hospital location, and teaching status have been shown to influence in-hospital outcomes, all of which are defined and can be adjusted using the national inpatient database [15,16,17].

2.3. Statistical Methods

Data were analyzed using the Software for Statistics and Data Science (STATA/MP 18.0, Stata Corp, College Station, TX, USA). A univariate screen was initially performed to assess different outcomes in complete heart block patients. Multivariate logistic regression was then used to adjust for potential confounders, including age, sex, race, median income, patient comorbidities (measured using the Charlson Comorbidity Index), hospital location (rural or urban), geographic region (Northeast, Midwest, West, or South), hospital academic status, hospital bed size, and primary expected payer or insurance status. Continuous variables were expressed as means (95% CI), and regression analysis was employed to compare differences between weekday and weekend admissions. The chi-squared test was used to compare categorical variables. Throughout the analysis, a two-sided p-value of <0.05 was considered statistically significant.

3. Results

3.1. Patient Characteristics

The NIS 2020 database was used for this study, consisting of 32,355,827 hospitalizations. Out of this, 37,480 patients were admitted with complete heart block, with 603 (1.61%) having contaminant malnutrition. A total of 393 (1.05%) patients had severe malnutrition, whereas 210 (0.57%) patients had mild to moderate malnutrition. Compared to the complete heart block patients without malnutrition, patients with malnutrition were older and had a higher Charlson Comorbidity score. Table 1 compares the demographic- and hospital-related characteristics of complete heart block patients with and without malnutrition.

3.2. Primary Outcome: Mortality

The total in-hospital mortality for patients admitted with complete heart block was 2.03% (760 patients). Mortality rates for complete heart block patients with malnutrition were significantly higher at 3.21% (4.63% in the severe malnutrition group and 2.59% in the mild–moderate malnutrition group). Both univariable as well as multivariable analyses adjusted for patient- and hospital-level confounders showed that CHB patients with malnutrition had significantly higher odds for mortality (aOR 2.61; 95% CI 1.46–3.48).

3.3. Secondary Outcomes

3.3.1. Resource Utilization: Length of Stay and Hospital Charges

Resource utilization was analyzed by determining the length of stay and the hospital charges. The mean hospital length of stay in CHB patients with malnutrition was significantly longer with a mean of 5.95 days (95% CI 4.63–7.87; p < 0.01) than the patients without malnutrition with a mean of 3.72 days (95% CI 3.63–3.81). The mean LOS in the severe malnutrition and mild–moderate malnutrition groups was 6.72 days and 4.41 days, respectively.
Complete heart block patients with malnutrition also had significantly higher hospital charges with a mean of USD 176,704.7 (95% CI 141,423.7–211,985.7; p < 0.01), as opposed to CHB without malnutrition with a mean of USD 99,797.38 (95% CI 96,981.44–102,613.3). These results represent a significant burden of complete heart block with concomitant malnutrition on the healthcare resources. Table 2 depicts and compares the important outcomes in CHB patients with and without malnutrition.

3.3.2. Complications

After adjusting for patient- and hospital-level confounders, CHB patients with malnutrition had significantly higher rates of cardiogenic shock (aOR 2.80; 95% CI 1.56–5.03; p < 0.01) and acute respiratory failure (aOR 2.65; 95% CI 1.67–4.22; p < 0.01) compared with patients without malnutrition. However, patients with malnutrition had similar rates of cardiac arrest (aOR 1.87; 95% CI 0.96–3.66; p = 0.07) as opposed to those without malnutrition.

3.3.3. In-Hospital Permanent Pacemaker (PPM) and Time to Permanent Pacemaker

For all the patients admitted with CHB, a permanent pacemaker (PPM) was implanted in 80.41% of the admissions. CHB patients with malnutrition had a significantly lower chance of obtaining a permanent pacemaker when compared to CHB patients without malnutrition (adjusted OR 0.57; 95% CI 0.38–0.86; p < 0.01) when adjusting for patient- and hospital-level confounders. Furthermore, the CHB admissions with malnutrition were found to have a significant delay in this intervention, with the mean time to pacemaker implantation at 2.80 days (95% CI 1.84–3.75; p = 0.01), as opposed to patients without malnutrition with a mean time to pacemaker implantation of 1.42 days (95% CI 1.37–1.47).

4. Discussion

This population-based nationwide study analyzed the impact of malnutrition on the in-hospital outcomes in patients admitted with complete heart block. To our knowledge, this is the first study of its kind in this patient population. The main findings of the study were as follows: CHB patients admitted with malnutrition had higher rates of in-hospital mortality as compared to the patients without malnutrition. Patients with malnutrition had more complications than those without malnutrition, with higher rates of cardiogenic shock and acute respiratory failure. The rates of permanent pacemaker implantation were lower in the malnutrition group and the time for this intervention to be made was also significantly longer in this group. Patients with malnutrition had longer lengths of stay and also incurred higher hospital charges. The impact on hospital and patient outcomes was in proportion to the degree of malnutrition, with patients with severe malnutrition having worse outcomes as compared to patients with mild to moderate malnutrition.
In our study, malnutrition was associated with approximately 1.5-fold increased risk of mortality within hospitals for patients admitted with complete heart block. Malnutrition has been previously associated with a significant increase in mortality in various cardiovascular conditions [5,6,7,8]. Studies specifically assessing malnutrition and arrythmias are scarce. A study of 521 patients showed that malnutrition is associated with increased mortality risk in patients undergoing permanent pacemaker implantation for bradycardia, with the geriatric nutritional risk index (GNRI) having a high predictive value for all-cause mortality [18]. In a large study involving 821,630 hospitalized patients with atrial fibrillation, malnutrition was associated with significantly worse in-hospital mortality and morbidity [10]. Along with mortality, complications including cardiogenic shock and acute respiratory failure were also notably higher in complete heart block patients with malnutrition. Inadequate protein and energy intake have been shown to cause proportional loss of myocardial mass, impeding the ability to generate cardiac output and subsequent increased risk of complications [19].
In our cohort, we observed significant racial disparities, with African American and Hispanic patients more commonly represented among those with malnutrition. This finding aligns with the existing literature that demonstrates racial and ethnic minority populations are disproportionately affected by social determinants of health, including food insecurity, lower socioeconomic status, and reduced access to healthcare services [20]. These factors may contribute not only to higher rates of malnutrition but also to delayed diagnosis and treatment, potentially compounding the adverse outcomes observed in this population. Addressing these disparities requires a multifaceted approach, including improved access to nutritional support, culturally tailored healthcare interventions, and broader public health strategies aimed at reducing social inequities.
Ferik et al. demonstrated that poor nutritional status is linked to an increased risk of arrhythmic events in 24 h Holter monitoring [9]. Bradycardia is the most common abnormality in anorexia nervosa, a psychiatric disorder associated with protein–energy malnutrition due to restrictive eating patterns [21,22]. Various mechanisms can explain the association of heart blocks with malnutrition. Malnutrition, especially when severe, can cause bradyarrhythmia by virtue of increased vagal tone in the body’s attempt to conserve energy [23,24]. Nutritional deficiencies can lead to myocardial atrophy and fibrosis, directly causing rhythm abnormalities by inducing structural and functional changes in the heart [25]. Associated electrolyte abnormalities in malnourished populations are well known to cause arrythmias. These mechanisms show a dose–response relationship, with higher severity of malnutrition contributing to poor outcomes in complete heart block, as noted in the current study. Mortality and resource utilization, measured by total hospital length of stay and hospitalization charges, were higher in the severe malnutrition group than in mild to moderate malnutrition.
Malnutrition in complete heart block was associated with lesser rates of permanent pacemaker implantation. Patients with malnutrition are more likely to have a reversible etiology for complete heart block, including severe electrolyte abnormalities, preventing the eventual need for permanent pacemaker implantation. Malnutrition is often a marker of frailty and poor prognosis, which may influence clinical decision-making toward palliative approaches or conservative management rather than invasive procedures. Furthermore, malnutrition can be associated with a significantly increased risk of complications after invasive and percutaneous procedures, potentially leading to fewer interventions being made in this population [18,26,27]. Frail populations with low body mass index and thin myocardium are at an increased risk of serious PPM implantation complications like pneumothorax, perforation, erosion, and rupture [28]. An additional key finding in the study was that patients with malnutrition had significant delays in PPM implantation as opposed to patients without malnutrition. This could be explained by the use of temporary pacing options to support hemodynamics to cover the time spent in correcting reversible factors in the malnourished population before definitive PPM intervention is carried out. Increased time spent in preprocedural assessment and clearance of this high-risk population could also explain this delay. Unfortunately, the NIS database does not capture clinical rationale or decision-making processes, limiting our ability to distinguish between different possibilities. Further prospective research is needed to better understand the underlying factors influencing management strategies in malnourished patients with complete heart block.
There are some limitations of this study. Firstly, as this was a retrospective study requiring the use of ICD-10 codes, it is subject to misclassification bias. However, the ICD-10 coding for malnutrition has been shown to have high accuracy and positive predictive value [29,30]. As an administrative database was used for study analysis with predefined variables, certain important parameters cannot be assessed, including the cause of mortality, laboratory values, the etiology of complete heart block, and treatments received. Despite these limitations, the substantial amount of data in the NIS helps provide adequate power to understand the drastic impact of malnutrition in complete heart block patients. Further, large-scale interventional studies are needed to reinforce the study findings. Early diagnosis and timely nutritional interventions can play a key factor in improving the hospital outcomes of admitted CHB patients.

5. Conclusions

Malnutrition has a significant effect on the in-hospital outcomes in patients admitted with complete heart block, with approximately 1.5-fold increased risk of mortality and increased risk of drastic complications, including cardiogenic shock and acute respiratory failure. CHB patients with malnutrition also had a significant burden on healthcare resources, with increased length of stay and hospitalization charges. The impact on these outcomes was proportional to the degree of malnutrition, with the severe malnutrition group having worse outcomes than the mild to moderate malnutrition group. Patients with malnutrition had significantly lower and delayed permanent pacemaker implantation rates. Given these findings, more evidence is needed to analyze the impact of early diagnosis and individualized nutritional support in improving short- and long-term outcomes in patients with complete heart block.

Author Contributions

Conceptualization, N.B.; methodology, N.B. and S.S.; software N.B. and F.S.; formal analysis N.B. and N.S.; writing—original draft preparation, N.B., S.S., J.K. and F.S.; writing—review and editing, N.S.; supervision, S.Q. All authors have read and agreed to the published version of the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Institutional Review Board Statement

Ethical review and approval were waived for this study as it utilized the National Inpatient Sample (NIS) database, which contains de-identified patient information and publicly available. According to our institution’s policy, studies using de-identified data are exempt from IRB review.

Informed Consent Statement

Informed consent was waived because the study used the National Inpatient Sample (NIS) database, which contains de-identified data, ensuring patient privacy and making it impractical to obtain individual consent.

Data Availability Statement

Data Availability Statements are available upon request, through the corresponding author.

Conflicts of Interest

The authors have no conflicts of interest to disclose.

Appendix A

Table A1. ICD 10-CM codes used for various conditions in the study.
Table A1. ICD 10-CM codes used for various conditions in the study.
ConditionICD10-CM Codes
Complete heart block I442
MalnutritionE40, E41, E42, E43, E44, E45, E46
Severe malnutritionE42, E43
Mild to moderate malnutritionE40, E44, E45, E46
Acute respiratory failure J9600, J9601, J9602, J9620, J9621, J9622, J9690, J9691, J9692
Cardiac arrestI462, I468, I469
Cardiogenic shock R570
Pacemaker 0JH604Z, 0JH634Z, 0JH804Z, 0JH834Z, 0JH605Z, 0JH635Z, 0JH805Z, 0JH835Z, 0JH606Z, 0JH636Z, 0JH806Z, 0JH836Z

References

  1. Knabben, V.; Chhabra, L.; Slane, M. Third-Degree Atrioventricular Block; StatPearls: Treasure Island, FL, USA, 2024. Available online: https://www.ncbi.nlm.nih.gov/books/NBK545199/ (accessed on 18 October 2024).
  2. Kashou, A.H.; Goyal, A.; Nguyen, T.; Ahmed, I.; Chhabra, L. Atrioventricular Block. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2024. [Google Scholar]
  3. Gregoratos, G.; Cheitlin, M.D.; Conill, A.; Epstein, A.E.; Fellows, C.; Ferguson, T.B.; Freedman, R.A., Jr.; Hlatky, M.A.; Naccarelli, G.V.; Saksena, S.; et al. ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary. Circulation 1998, 97, 1325–1335. [Google Scholar] [CrossRef]
  4. World Health Organization. Malnutrition. Available online: https://www.who.int/news-room/fact-sheets/detail/malnutrition (accessed on 10 March 2025).
  5. Li, P.; Li, C.; Mishra, A.K.; Cai, P.; Lu, X.; Sherif, A.A.; Jin, L.; Wang, B. Impact of malnutrition on in-hospital outcomes in takotsubo cardiomyopathy. Nutrition 2022, 93, 111495. [Google Scholar] [CrossRef] [PubMed]
  6. Sun, X.; Luo, L.; Zhao, X.; Ye, P. Controlling Nutritional Status (CONUT) score as a predictor of all-cause mortality in elderly hypertensive patients: A prospective follow-up study. BMJ Open 2017, 7, e015649. [Google Scholar] [CrossRef]
  7. Yoo, S.H.; Kook, H.; Hong, Y.J.; Kim, J.H.; Ahn, Y.; Jeong, M.H. Influence of undernutrition at admission on clinical outcomes in patients with acute myocardial infarction. J. Cardiol. 2017, 69, 555–560. [Google Scholar] [CrossRef] [PubMed]
  8. Sujino, Y.; Tanno, J.; Nakano, S.; Funada, S.; Hosoi, Y.; Senbonmatsu, T.; Nishimura, S. Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction. J. Cardiol. 2015, 66, 263–268. [Google Scholar] [CrossRef] [PubMed]
  9. Ferik, O.K.; Akbuga, K.; Tolunay, H.E.; Aslan, T.; Eren, M.; Erkan, A.F.; Ekici, B.; Ercan, E.A.; Kervancıoglu, C. Poor Nutritional Status Is Associated with Arrhythmic Events on 24-Hour Holter Recording. Med. Princ. Pract. 2022, 31, 368–375. [Google Scholar] [CrossRef]
  10. Markson, F.E.; Akuna, E.; Asemota, I.; Areoye, G.; Shahi, A.; Nwachukwu, P.; Ong, K. Protein–Energy Malnutrition Is Associated with Worse Outcomes in Patients with Atrial Fibrillation: A Nationwide Analysis. J. Innov. Card. Rhythm Manag. 2023, 14, 5538–5545. [Google Scholar] [CrossRef]
  11. Dobak, S.; Peterson, S.J.; Corrigan, M.L.; Lefton, J. Current Practices and Perceived Barriers to Diagnosing, Documenting, and Coding for Malnutrition: A Survey of the Dietitians in Nutrition Support Dietetic Practice Group. J. Acad. Nutr. Diet. 2017, 118, 978–983. [Google Scholar] [CrossRef]
  12. Abugroun, A.; Nayyar, A.; Abdel-Rahman, M.; Patel, P. Impact of malnutrition on hospitalization outcomes for older adults admitted for sepsis. Am. J. Med. 2021, 134, 221–226. [Google Scholar] [CrossRef]
  13. Q&A: Documentation and ICD-10-CM Coding for Severe Malnutrition [Internet]. Acdis.org. Available online: https://acdis.org/articles/qa-documentation-and-icd-10-cm-coding-severe-malnutrition (accessed on 18 October 2024).
  14. Quan, H.; Li, B.; Couris, C.M.; Fushimi, K.; Graham, P.; Hider, P.; Januel, J.-M.; Sundararajan, V. Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 Countries. Am. J. Epidemiol. 2011, 173, 676–682. [Google Scholar] [CrossRef]
  15. Walicka, M.; Chlebus, M.; Śliwczyński, A.; Brzozowska, M.; Rutkowski, D.; Czech, M.; Tuszyńska, A.; Jacyna, A.; Puzianowska-Kuźnicka, M.; Franek, E. Predictors of in-hospital mortality in nonsurgical departments: A multivariable regression analysis of 2 855 029 hospitalizations. Pol. Arch. Intern. Med. 2020, 130, 268–275. [Google Scholar] [PubMed]
  16. Rush, B.; Wiskar, K.; Celi, L.A.; Walley, K.R.; Russell, J.A.; McDermid, R.C.; Boyd, J.H. Association of Household Income Level and In-Hospital Mortality in Patients with Sepsis: A Nationwide Retrospective Cohort Analysis. J. Intensive Care Med. 2018, 33, 551–556. [Google Scholar] [CrossRef]
  17. Chesley, C.F.; Chowdhury, M.; Small, D.S.; Schaubel, D.; Liu, V.X.; Lane-Fall, M.B.; Halpern, S.D.; Anesi, G.L. Racial disparities in length of stay among severely ill patients presenting with sepsis and acute respiratory failure. JAMA Netw. Open 2023, 6, e239739. [Google Scholar] [CrossRef]
  18. Yamaguchi, T.; Nozato, T.; Miwa, N.; Sagawa, Y.; Watanabe, K.; Nagata, Y.; Miyazaki, R.; Mitsui, K.; Nagase, M.; Nagamine, T.; et al. Impact of the preprocedural nutrition status on the clinical outcomes of patients after pacemaker implantation for bradycardia. J. Cardiol. 2019, 74, 284–289. [Google Scholar] [CrossRef] [PubMed]
  19. Webb, J.G.; Kiess, M.C.; Chan-Yan, C.C. Malnutrition and the heart. CMAJ 1986, 135, 753–758. [Google Scholar] [PubMed]
  20. Berkowitz, S.A.; Seligman, H.K.; Meigs, J.B.; Basu, S. Food insecurity, healthcare utilization, and high cost: A longitudinal cohort study. Am. J. Manag. Care 2018, 24, 399–404. [Google Scholar]
  21. Sachs, K.V.; Harnke, B.; Mehler, P.S.; Krantz, M.J. Cardiovascular complications of anorexia nervosa: A systematic review. Int. J. Eat. Disord. 2016, 49, 238–248. [Google Scholar] [CrossRef]
  22. Kohn, M.R.; Golden, N.H. Management of the malnourished patient: It’s now time to revise the guidelines. J. Eat. Disord. 2022, 10, 56. [Google Scholar] [CrossRef]
  23. Divasta, A.D.; Walls, C.E.; Feldman, H.A.; Quach, A.E.; Woods, E.R.; Gordon, C.M.; Alexander, M.E. Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. Arch. Pediatr. Adolesc. Med. 2010, 164, 706–713. [Google Scholar] [CrossRef]
  24. Kollai, M.; Bonyhay, I.; Jokkel, G.; Szonyi, L. Cardiac vagal hyperactivity in adolescent anorexia nervosa. Eur. Heart J. 1994, 15, 1113–1118. [Google Scholar] [CrossRef]
  25. Faddan, N.H.A.; Sayh, K.I.E.; Shams, H.; Badrawy, H. Myocardial dysfunction in malnourished children. Ann. Pediatr. Cardiol. 2010, 3, 113–118. [Google Scholar] [CrossRef] [PubMed]
  26. Kim, D.; Shim, J.; Kim, Y.G.; Yu, H.T.; Kim, T.-H.; Uhm, J.-S.; Choi, J.-I.; Joung, B.; Lee, M.-H.; Kim, Y.-H.; et al. Malnutrition and risk of procedural complications in patients with atrial fibrillation undergoing catheter ablation. Front. Cardiovasc. Med. 2021, 8, 736042. [Google Scholar] [CrossRef] [PubMed]
  27. Unosawa, S.; Taoka, M.; Osaka, S.; Yuji, D.; Kitazumi, Y.; Suzuki, K.; Kamata, K.; Sezai, A.; Tanaka, M. Is malnutrition associated with postoperative complications after cardiac surgery? J. Card. Surg. 2019, 34, 908–912. [Google Scholar] [CrossRef] [PubMed]
  28. Cotter, R.; Lyden, J.; Mehler, P.S.; Miceli, J.; Schuller, J.; Krantz, M.J. A case series of profound bradycardia in patients with severe anorexia nervosa: Thou shall not pace? HeartRhythm Case Rep. 2019, 5, 511–515. [Google Scholar] [CrossRef]
  29. Khalatbari-Soltani, S.; Waeber, G.; Marques-Vidal, P. Diagnostic accuracy of undernutrition codes in hospital administrative discharge database: Improvements needed. Nutrition 2018, 55, 111–115. [Google Scholar] [CrossRef]
  30. Rasmussen, N.H.; Thomsen, R.W.; Rasmussen, H.H.; Søgaard, M. Validity of diagnostic coding for undernutrition in hospitals. Clin. Nutr. 2016, 35, 491–495. [Google Scholar] [CrossRef]
Table 1. Demographics and hospital characteristics of patients with complete heart block with and without contaminant malnutrition.
Table 1. Demographics and hospital characteristics of patients with complete heart block with and without contaminant malnutrition.
Variable With MalnutritionWithout Malnutritionp-Values
n (%) of patients with complete heart block 603 (1.61)36,877 (98.39)
Mean Age (years ± SD) 78.19 ± 9.1475.54 ± 7.940.006
Female Gender (n, %)284 (47.11)15,880 (43.05)0.39
Race (n, %) 0.001
Caucasian393 (65.17)28,697 (77.82)
African American120 (19.90)3151 (8.54)
Hispanic63 (10.45)2954 (8.01)
Asian or Pacific Islander<6 (<1.00)960 (2.60)
Native American10 (1.66)369 (1.00)
Others16 (2.65)922 (2.50)
Median Income in Patients’ Zip Code (n, %) 0.19
USD 1–USD 47,999167 (27.69)8936 (24.23)
USD 48,000–USD 60,999193 (32.01)9901 (26.85)
USD 61,000–USD 81,999101 (16.75)9238 (25.05)
≥USD 82,000142 (23.55)8802 (23.87)
Charlson Comorbidity Index (n, %) <0.001
030 (4.98)7455 (20.22)
185 (14.10)8064 (21.87)
2110 (18.24)7040 (19.09)
3 or more379 (62.85)14,318 (38.83)
Hospital Region (n, %) 0.79
Northeast105 (17.41)7689 (20.85)
Midwest150 (24.88)8331 (22.59)
South219 (36.32)13,508 (36.63)
West129 (21.39)7349 (19.93)
Hospital Bed Size (n, %) 0.22
Small75 (12.44)6672 (18.09)
Medium170 (28.19)10,860 (29.45)
Large358 (59.37)19,345 (52.46)
Hospital Location (n, %) 0.62
Rural40 (6.63)2093 (5.68)
Urban 563 (93.37)34,784 (94.32)
Hospital Teaching Status (n, %)
Non-Teaching 129 (21.39)8823 (23.93)
Teaching 474 (78.61)28,054 (76.07)
Comorbidities (%) <0.05
Diabetes without complications 60 (9.95)6912 (18.74)
Diabetes with complications199 (33.00)7627 (20.68)
COPD159 (26.37)7296 (19.78)
Dementia144 (23.88)3669 (9.95)
Cancer 55 (9.12)1147 (3.11)
Hypertension105 (17.36)14,747 (39.99)
Hyperlipidemia 309 (51.24)21,363 (57.93)
Chronic kidney disease (CKD)279 (46.28)10,871 (29.48)
Non-dialysis CKD 219 (36.36)9584 (25.99)
Dialysis CKD 60 (9.92)1435 (3.89)
Peptic ulcer disease10 (1.66)144 (0.39)
p value ≤ 0.05 indicates significance.
Table 2. Comparison of major outcomes in complete heart block patients with and without malnutrition.
Table 2. Comparison of major outcomes in complete heart block patients with and without malnutrition.
Variables/OutcomesComplete Heart Block with Malnutrition Complete Heart Block Without Malnutritionp Value
n (%)60336,877
Death (%)193 (3.21)567 (1.53)0.003
Acute respiratory failure (%)179 (29.75)3725 (10.1)<0.001
Cardiogenic shock (%)50 (8.22)14,640 (3.97)0.001
Cardiac arrest (%)42 (6.92)1633 (4.43)0.06
PPM rates (%)409 (67.77)29,656 (80.42)<0.001
Mean LOS in days (95% CI)5.95 (4.63–7.87)3.72 (3.63–3.81) <0.001
Mean total charges in USD (95% CI)176,704.7 (141,423.7–211,985.7)99,797.38 (96,981.44–102,613.3)<0.001
Mean time to PPM (95% CI)2.8 (1.84–3.75)1.41 (1.36–1.46)0.01
p value ≤ 0.05 indicates significance.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Bansal, N.; Singla, S.; Kaur, J.; Sharma, N.; Sultan, F.; Qiu, S. Association of Malnutrition in Patients Admitted with Complete Heart Block: A Nationwide Analysis. Obesities 2025, 5, 18. https://doi.org/10.3390/obesities5010018

AMA Style

Bansal N, Singla S, Kaur J, Sharma N, Sultan F, Qiu S. Association of Malnutrition in Patients Admitted with Complete Heart Block: A Nationwide Analysis. Obesities. 2025; 5(1):18. https://doi.org/10.3390/obesities5010018

Chicago/Turabian Style

Bansal, Nahush, Sonaal Singla, Jasneet Kaur, Nikita Sharma, Feehaan Sultan, and Shuhao Qiu. 2025. "Association of Malnutrition in Patients Admitted with Complete Heart Block: A Nationwide Analysis" Obesities 5, no. 1: 18. https://doi.org/10.3390/obesities5010018

APA Style

Bansal, N., Singla, S., Kaur, J., Sharma, N., Sultan, F., & Qiu, S. (2025). Association of Malnutrition in Patients Admitted with Complete Heart Block: A Nationwide Analysis. Obesities, 5(1), 18. https://doi.org/10.3390/obesities5010018

Article Metrics

Back to TopTop