Cardiac Arrhythmias are Associated with Adverse Outcomes in Patients Admitted with Hypoglycemia

Objective : Hypoglycemia has been linked to increased mortality in outpatient and inpatient settings, however, the underlying mechanism is still unknown. Prior observational studies have reported hypoglycemia-induced arrhythmias from bradyarrhythmias to ventricular fibrillation. We examined the Nationwide Inpatient Sample (NIS) for trends and outcomes with hypoglycemia-induced arrhythmias

Methods: We analyzed data for patients admitted to hospitals in the United States (US) from 2016 to 2018 with a primary diagnosis of hypoglycemia using NIS. Further, we selected patients with Cardiac arrhythmias (CAS) and evaluated baseline characteristics and discharge outcomes

Results: A total of 17310 patients were admitted with hypoglycemia over 3 years, 2210 had different cardiac arrhythmias including atrial fibrillation/ flutter (42.0%), sinus bradycardia (30.8%), sinus tachycardia (22%), ventricular fibrillation (0.87%), atrial/ventricular premature complex (8.02%) with some overlap accounting for the total being slightly over 100%. Hypoglycemia with cardiac arrhythmias was non significantly associated with female gender, (55.1% versus 44.9%, p= 0.082), and older age (60.7 ± 25.7 years versus 47.5 ± 29.7 years, P < .0001). Mean length of stay was higher in hypoglycemic patients with arrhythmias (4.6 ± 5.4 versus 3.6 ± 4.7, p< .0001), as well as total hospital charges ($40716±40284 versus $31923 ± 45835, p < .0001). A total of 95 patients died among the cardiac arrhythmia group (50 atrial fibrillation/flutter, 20 sinus tachycardia, 15 sinus bradycardia, 10 ventricular fibrillation, 5 had atrial/ventricular premature complex). The in-hospital mortality was higher (4.1% versus 1.6%, p=0.01) among patients with cardiac arrhythmias (OR: 1.85, CI: 1.07-3.21, p=0.028 in multivariable analysis after adjusting for potential confounders (age, gender, diabetes, coronary artery disease, hypertension, renal failure, heart failure, and dyslipidemia).

Discussion/Conclusion: These data suggest that hypoglycemic patients with cardiac arrhythmias have worse clinical in-hospital outcomes including higher mortality and could benefit with more aggressive monitoring and management