Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States

Tarun Bathini; Charat Thongprayoon; Api Chewcharat; Tananchai Petnak; Wisit Cheungpasitporn; Boonphiphop Boonpheng; Narut Prasitlumkum; Ronpichai Chokesuwattanaskul; Saraschandra Vallabhajosyula; Wisit Kaewput

doi:10.3390/jcm9051357

Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States

J Clin Med. 2020 May 6;9(5):1357. doi: 10.3390/jcm9051357.

Affiliations

¹ Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA.
² Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
³ Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
⁴ Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
⁵ Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
⁶ Department of Medicine, University of Hawaii, Honolulu, HI 96822, USA.
⁷ Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand.
⁸ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
⁹ Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand.

Abstract

Background: This study aimed to assess the risk factors and impact of acute myocardial infarction on in-hospital treatments, complications, outcomes, and resource utilization in hospitalized patients for heat stroke in the United States.

Methods: Hospitalized patients with a principal diagnosis of heat stroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Acute myocardial infarction was identified using the hospital International Classification of Diseases, Ninth Revision (ICD-9), diagnosis of 410.xx. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without acute myocardial infarction were compared.

Results: A total of 3372 heat stroke patients were included in the analysis. Of these, acute myocardial infarction occurred in 225 (7%) admissions. Acute myocardial infarction occurred more commonly in obese female patients with a history of chronic kidney disease, but less often in male patients aged <20 years with a history of hypothyroidism. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with acute myocardial infarction. Acute myocardial infarction was associated with rhabdomyolysis, metabolic acidosis, sepsis, gastrointestinal bleeding, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, circulatory failure, liver failure, neurological failure, and hematologic failure. Patients with acute myocardial infarction had 5.2-times greater odds of in-hospital mortality than those without myocardial infarction. The length of hospital stay and hospitalization cost were also higher when an acute myocardial infarction occurred while hospitalized.

Conclusion: Acute myocardial infarction was associated with worse outcomes and higher economic burden among patients hospitalized for heat stroke. Obesity and chronic kidney disease were associated with increased risk of acute myocardial infarction, while young male patients and hypothyroidism were associated with decreased risk.

Keywords: heat stroke; hospitalization; myocardial infarction; outcomes; resource utilization.