The inpatient burden associated with Takayasu's arteritis is considerable, and these patients have a high prevalence of cardiovascular comorbidities, a nationwide U.S. study found.
The mean length of stay for patients hospitalized with Takayasu's arteritis was 7.35 days and the mean total hospitalization charges were $89,973, according to Patompong Ungprasert, MD, of Mahidol University in Bangkok, Thailand, and formerly of the Mayo Clinic in Rochester, Minnesota.
And those patients had significantly increased odds of stroke, aortic aneurysm, aortic valvulopathy, and peripheral vascular disease, the researchers reported online in .
Takayasu's arteritis is a chronic granulomatous vasculitis that predominantly involves the aorta and its major branches and is most often seen in young women ages 25 to 30. The condition is more prevalent in Asia, and in the U.S., its annual incidence has been estimated at three incident cases per million population. Little is known about the costs of hospitalization and the pattern of complications for the condition.
To explore this, the researchers analyzed data for the years 2013 and 2014 from the , a large U.S. database sponsored by the Agency for Healthcare Research and Quality.
The analysis included more than 14 million adult hospital admissions; these were considered representative of 95% of hospital discharges nationwide.
Resource utilization included not only length of hospital stay, but also procedures such as aortic valve replacement, arteriography, magnetic resonance imaging, and peripheral vascular interventions. Hospital charges represented the amount of money billed by the hospital for each patient, while hospital costs represented the amount invested by the institution in providing care.
Each of the 2,680 admissions among patients with Takayasu's arteritis during the study period was propensity score-matched with a non-Takayasu's patient. Mean age was 49, more than 80% were women, and the majority were white.
The inpatient prevalence was 4.6 cases per 100,000 admissions, which was higher than would be expected, the authors noted.
The most common causes for admission were chest pain, acute myocardial infarction, stroke, sepsis, and infections such as pneumonia and cellulitis.
On a multivariate regression analysis that compared Takayasu's patients with propensity-matched controls, patients had a significantly higher likelihood of these comorbidities:
- Aortic aneurysm, OR 40.76, 95% CI 9.13-181.7 (P<0.01)
- Aortic valvulopathy, OR 4.92, 95% CI 2.09-11.55 (P<0.01)
- Stroke, OR 4.66, 95% CI 2.10-10.31 (P<0.01)
- Peripheral vascular disease, OR 4.41, 95% CI 1.22-3.32 (P<0.01)
The crude mortality rate during hospitalization was 2.8%, but after adjustment for potential confounders such as income, hospital size, and urban location, the adjusted odds ratio for mortality was nonsignificant (OR 1.44, 95% CI 0.58-3.61, P=0.43).
Patients with Takayasu's arteritis had longer hospital stays than controls, by an average of 2.1 days. They were also more likely to undergo arteriography (OR 6.82, 95% CI 2.79-16.68, P<0.01) and peripheral vascular interventions (OR 4.41, 95% CI 1.61-12.10, P<0.01).
Hospital costs for patients with Takayasu's were a mean of $11,275 (95% CI 4,946-17,603) higher than for controls, and the mean total hospitalization charges were $45,305 (95% CI 23,063-67,546) higher than for controls.
The reasons for the higher hospitalization costs are likely to include the severity of the condition and its complications and comorbidities, which often require aggressive parenteral and invasive treatments, according to researchers. The higher hospital charges, in contrast, are similar to what has been seen for other conditions and may reflect current insurance models and policies.
With regard to the high rates of comorbidities seen, the authors noted that aortic aneurysm "could be a direct consequence of the disease, as the inflammation of Takayasu's arteritis can lead to the damage of the elastic lamina and the tunica media, resulting in a weakened aortic wall and formation of aneurysms."
Moreover, peripheral vascular disease could result from dilation of the ascending aorta and aortic regurgitation as well as inflammation of the iliofemoral and subclavian arteries.
Other studies have also found high rates of stroke in patients with Takayasu's arteritis. Reasons for this may include resistant hypertension associated with stenosis of the renal artery and the development of emboli in the extracranial arteries.
Unlike in this study, mortality in previous studies was reported as being increased threefold overall, Takayasu and colleagues noted. This discrepancy likely reflects the fact that only inpatient mortality was addressed in this analysis, the team said.
An important strength of the study was its large, representative population, while a limitation was the possibility of coding inaccuracies in the database.
The study findings "suggest that the inpatient burden of Takayasu's arteritis is not negligible and its importance may have been overlooked," Ungprasert and co-authors concluded.
Disclosures
The authors reported having no conflicts of interest.
Primary Source
Seminars in Arthritis & Rheumatism
Ungprasert P, et al "Inpatient prevalence, burden, and comorbidity of Takayasu's arteritis: Nationwide Inpatient Sample 2013-2014" Semin Arthritis Rheum 2018; doi:10.1016/j.semarthrit.2018.11.008.