Analyzing the Effect of Pregnancy in Patients With Inflammatory Bowel Disease (IBD) and Cardiac Arrythmias

Background: Inflammatory Bowel Disease (IBD) can have numerous complications involving all organ systems, especially the cardiovascular system. There are many cardiac conditions that occur during pregnancy, especially arrhythmias. There is limited data investigating the effect of pregnancy on outcomes in patients with IBD and cardiac disease. The aim of our study was to examine the impact of pregnancy in patients with IBD and cardiac arrhythmias, as well as to, identify risk factors that worsen outcomes in this patient population. Methods: The Nationwide Inpatient Sample (NIS) is the largest publicly available all-payer inpatient care database in the United States. Data was extracted from the National Inpatient Sample (NIS) Database for the years 2015-2020. Pregnant patients aged 18 years and above with a diagnosis of IBD and cardiac arrhythmias versus non-pregnant patients with IBD and cardiac arrhythmias were identified using ICD codes. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges (TOTHC) using STATA 17. Results: We identified 222,000 non-pregnant patients with IBD and concomitant cardiac arrhythmias and 37, 885 pregnant patients with IBD and cardiac arrhythmias. In the pregnant population, we found: 19,945 patients with atrial fibrillation, 4450 with ventricular tachycardia (VT), 2605 with atrial flutter, and 3285 with supraventricular tachycardia (SVT). The average age was 57 years. Positive predictors of increased mortality in the pregnant population included: the presence of any arrhythmia (OR 2.23, p= 0.00, CI: 2.01-2.47), fistula (OR 2.66, p =0.00, CI: 1.97-3.60), Acute kidney injury (AKI) (OR 5.33, p=0.00, CI: 4.54-6.24), hematochezia (OR 1.89, P< 0.03, CI: 1.24-2.87), VT (OR 2.47, p= 0.00, CI: 1.83- 3.32), SVT (OR 2.90, p=0.00, CI: 2.07 - 4.05). Positive predictors of increased LOS included the presence of any arrhythmia (2.35, p= 0.00, CI: 2.15- 2.55), Fistula (6.68, p=0.00, CI: 5.89-7.48), AKI (3.03, p= 0.00, CI: 2.77-3.29), Intestinal obstruction (2.57, p= 0.00, CI: 1.92-3.22), hematochezia (2.69, p=0.00, CI: 1.90-3.48), bowel resection (5.57, p = 0.00, CI: 4.90-6.23), VT (2.15, p= 0.00, CI: 1.42- 2.90), SVT (2.87, p=0.00, CI: 2.17-3.56) and Atrial Flutter (2.75, p=0.00, CI: 1.85-3.65). Statistically significant (p < 0.05) positive predictors of increased TOTHC included the presence of any arrhythmia, Hispanic race, fistula, AKI, intestinal obstruction, hematochezia, bowel resection, SVT, atrial flutter, and VT. Conclusions: Our study identified various risk factors that worsen inpatient outcomes in pregnant patients with IBD and cardiac arrhythmias. Our study is novel because there is a paucity of data that investigate the clinical outcomes associated with this special population. Our study demonstrates that the presence of arrhythmias, AKI, fistula, or hematochezia poses a significant mortality risk in pregnant patients with IBD.