<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Title</h3>
<p>Seasonal Variations of Arrhythmias and Their Impact on Mortality in Cancer Patients with Health Disparities: A Propensity Score Adjusted Machine Learning Analysis of over 100 Million Hospitalizations Across 3 Years</p>
</sec>
<sec>
<h3>Background</h3>
<p>Arrhythmias are observed to increase during high influenza activity seasons (HIA, December to February) with significant clinical impact among high-risk patients, so their outcomes may be optimized through closer monitoring of these populations. It is unknown if cancer is such a risk factor.</p>
</sec>
<sec>
<h3>Methods</h3>
<p>This is a retrospective analysis of arrhythmia-related mortality and the effect of health disparities in patients with cancer during HIA and non-HIA seasons in a nationally representative database. Machine learning-augmented propensity score adjusted multivariable regression (ML-PSr) was performed using the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer hospitalized dataset.</p>
</sec>
<sec>
<h3>Results</h3>
<p>A number of 16,795,379 (18.48%) patients presented with arrhythmia of whom 3,214,914 (19.14%) were during HIA. In ML-PSr, HIA did not significantly increase the odds of arrhythmia for cancer patients (OR 1.01, 95%CI 0.99-1.03, p=0.37), but the odds of arrhythmia-related mortality were higher during HIA seasons (OR 1.19, 95%CI 1.12-1.27, p&lt;0.001) compared to non-HIA seasons (OR 1.17, 95%CI 1.13-1.22, p&lt;0.001). Primary malignancies with the highest prevalence of arrhythmias during HIA were that of the lung (19.60%), leukemia (11.49%), non-Hodgkin lymphoma (NHL) (8.24%), prostate (8.15%), and multiple myeloma (MM) (6.21%) (p&lt;0.001). HIA increased arrhythmia-related mortality most for the following primary malignancies by year: gastrointestinal in 2016 (OR 1.15, 95%CI 1.01-1.32, p=0.039), leukemia in 2017 (OR 1.31, 95%CI 1.10-1.54, p=0.002), GI in 2018 (OR 1.14, 95%CI 1.01-1.29, p=0.029), and renal in 2018 (OR 1.54, 95%CI 1.06-2.23, p=0.025). Among patients with active cancer and arrhythmia, African Americans had significantly greater mortality than Caucasians (OR 1.13, 95%CI 1.03-1.23, p=0.013), independent of socioeconomic and clinical confounders.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>This study suggests arrhythmia-related mortality was higher during HIA seasons compared to non-HIA seasons in cancer patients and showed notable disparities by race and worse outcomes by primary malignancy.</p>
</sec>
</abstract>

Title
Seasonal Variations of Arrhythmias and Their Impact on Mortality in Cancer Patients with Health Disparities: A Propensity Score Adjusted Machine Learning Analysis of over 100 Million Hospitalizations Across 3 Years


Background
Arrhythmias are observed to increase during high influenza activity seasons (HIA, December to February) with significant clinical impact among high-risk patients, so their outcomes may be optimized through closer monitoring of these populations. It is unknown if cancer is such a risk factor.


Methods
This is a retrospective analysis of arrhythmia-related mortality and the effect of health disparities in patients with cancer during HIA and non-HIA seasons in a nationally representative database. Machine learning-augmented propensity score adjusted multivariable regression (ML-PSr) was performed using the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer hospitalized dataset.


Results
A number of 16,795,379 (18.48%) patients presented with arrhythmia of whom 3,214,914 (19.14%) were during HIA. In ML-PSr, HIA did not significantly increase the odds of arrhythmia for cancer patients (OR 1.01, 95%CI 0.99-1.03, p=0.37), but the odds of arrhythmia-related mortality were higher during HIA seasons (OR 1.19, 95%CI 1.12-1.27, p<0.001) compared to non-HIA seasons (OR 1.17, 95%CI 1.13-1.22, p<0.001). Primary malignancies with the highest prevalence of arrhythmias during HIA were that of the lung (19.60%), leukemia (11.49%), non-Hodgkin lymphoma (NHL) (8.24%), prostate (8.15%), and multiple myeloma (MM) (6.21%) (p<0.001). HIA increased arrhythmia-related mortality most for the following primary malignancies by year: gastrointestinal in 2016 (OR 1.15, 95%CI 1.01-1.32, p=0.039), leukemia in 2017 (OR 1.31, 95%CI 1.10-1.54, p=0.002), GI in 2018 (OR 1.14, 95%CI 1.01-1.29, p=0.029), and renal in 2018 (OR 1.54, 95%CI 1.06-2.23, p=0.025). Among patients with active cancer and arrhythmia, African Americans had significantly greater mortality than Caucasians (OR 1.13, 95%CI 1.03-1.23, p=0.013), independent of socioeconomic and clinical confounders.


Conclusion
This study suggests arrhythmia-related mortality was higher during HIA seasons compared to non-HIA seasons in cancer patients and showed notable disparities by race and worse outcomes by primary malignancy.

Seasonal variations of arrhythmias and their impact on mortality in cancer patients with health disparities: A propensity score adjusted machine learning analysis of over 100 million hospitalizations across 3 years

Romanian Journal of Cardiology

This work is licensed under the Creative Commons Attribution 4.0 International License.

Title
Seasonal Variations of Arrhythmias and Their Impact on Mortality in Cancer Patients with Health Disparities: A Propensity Score Adjusted Machine Learning...

Outcome	Predictor	2016-2018	2016	2017	2018
Arrhythmia
Without active cancer	HIA	1.01 (1.01-1.02, p=0.003)	1.02 (1.01-1.04, p=0.009)	1.01 (1.00-1.01, p=0.001)	1.01 (1.01-1.02, p<0.001)
With active cancer	HIA	1.01 (0.99-1.03, p=0.367)	1.02 (1.00-1.04, p=0.031)	1.00 (0.98-1.02, p=0.939)	1.01 (1.00-1.03, p=0.132)
Mortality with cancer
Non-HIA	Arrythmia	1.17 (1.13-1.22, p<0.001)	1.18 (1.14-1.23, p<0.001)	1.15 (1.11-1.20, p<0.001)	1.17 (1.13-1.22, p<0.001)
HIA	Arrythmia	1.19 (1.12-1.27, p<0.001)	1.20 (1.12-1.28, p<0.001)	1.15 (1.08-1.23, p<0.001)	1.23 (1.16-1.31, p<0.001)
Cost with cancer (US$)
Non-HIA	Arrythmia	3474.68 (2988.81-4240.62, p<0.001)	3690.58 (2972.38-4408.78, p<0.001)	3371.19 (2631.76-4110.62, p<0.001)	3362.28 (2522.10-4202.45, p<0.001)
HIA	Arrythmia	2312.96 (981.69-3644.23, p=0.003)	3516.63 (2309.55-4723.71, p<0.001)	1771.52 (426.56-3116.48, p=0.010)	1650.72 (208.96-3092.49, p=0.025)

Seasonal variations of arrhythmias and their impact on mortality in cancer patients with health disparities: A propensity score adjusted machine learning analysis of over 100 million hospitalizations across 3 years

Article Category: Orginal Article

Published Online: Mar 29, 2024

Page range: 16 - 23

DOI: https://doi.org/10.2478/rjc-2024-0005

Keywords
arrhythmia, respiratory illness season, disparities, machine learning, cardio-oncology, cancer

© 2024 Jong Kun Park et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

ML-PS multivariable regression of arrhythmia, mortality, and cost by cancer and HIA*

Seasonal variations of arrhythmias and their impact on mortality in cancer patients with health disparities: A propensity score adjusted machine learning analysis of over 100 million hospitalizations across 3 years

Article Category: Orginal Article

Published Online: Mar 29, 2024

Page range: 16 - 23

DOI: https://doi.org/10.2478/rjc-2024-0005

Keywordsarrhythmia, respiratory illness season, disparities, machine learning, cardio-oncology, cancer

© 2024 Jong Kun Park et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

ML-PS multivariable regression of arrhythmia, mortality, and cost by cancer and HIA*

Keywords
arrhythmia, respiratory illness season, disparities, machine learning, cardio-oncology, cancer