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Malnutrition has been associated with inferior outcomes in patients with advanced heart failure (HF) therapy, which includes heart transplantation and Left Ventricular Assist Device implantation (LVAD). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity. Our cross-sectional study used Nationwide Readmission Database (NRD) for 2016-2019. First, we extracted all cases older than 18 years that received advanced heart failure therapy during the index admission. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4. We identified 27,409 discharges who received advanced HF therapy. Malnutrition was present in 27% of the study cohort (n=7,443 cases). Most malnourished patients (81%, n=6,034) had moderate-severe malnutrition. Patients with malnutrition were slightly older than those without malnutrition (mean age 56 years vs. 54 years, p<0.001) and had fewer women (22% vs. 24%, p<0.001). Univariate analysis showed that moderate-severe malnutrition is associated with higher inpatient mortality compared to no malnutrition (OR 2.36[2.04-2.72], p<0.001). Mild malnutrition was not associated with higher inpatient mortality (OR 1.04[0.75-1.44]). After adjusting for age, gender, cerebrovascular disease, acute encephalopathy, acute myocardial infarction, peptic ulcer disease, coagulopathy, peripheral vascular disease, as well as chronic kidney and liver diseases, the presence of moderate-severe malnutrition continued to be associated with higher inpatient mortality compared to those without malnutrition (aOR 1.74[1.48-2.05], p<0.001). Either degree of malnutrition was associated with higher 30-day readmission (aOR 1.16[1.06-1.27], p<0.001) and length of stay (mean of 56 days in moderate-severe malnutrition vs. mean of 52 days in mild malnutrition vs. mean of 33 days with no malnutrition, p<0.001). In patients receiving advanced HF therapy, malnutrition severity correlates with worse outcomes. [ABSTRACT FROM AUTHOR]

Right ventricular endomyocardial biopsy (EMB) is uncommonly used for patients admitted with myocarditis. In this study, we assessed the utilization of EMB and outcomes in patients admitted with myocarditis. We used the Nationwide Readmissions Database (NRD) from 2016 to 2019 to include patients ≥ 18 years of age with a primary diagnosis of myocarditis. Appropriate domain and Propensity Score (PS) analyses were applied using SAS 9.4. The outcomes were compared among patients who underwent EMB vs. those who did not. We included 11,927 cases of myocarditis, out of which only 378 patients (3.1%) had EMB. Patients who underwent EMB were older (mean age 45 vs. 41 years, p <0.01), more females (47% vs. 35%, p<0.01) compared to those who did not undergo EMB, respectively. Also, patients who underwent a biopsy, had higher rates of atrial fibrillation (19% vs. 7%), diabetes mellitus (18% vs. 11%), hypertension (40 vs. 34%), End-stage renal disease (4% vs. 1.3%), autoimmune disease (7% vs. 3%) and malignancy (13% vs. 3%) [p<0.01]. Patients who had EMB had higher incidence of cardiogenic shock (40% vs. 5%), ventricular tachycardia (30% vs. 7%), and sudden cardiac arrest (3.4% vs. 1.5%) [p<0.05]. They had higher inpatient mortality during index admission (5% vs. 1.5%), 30-day readmission (14% vs. 7%), hospitalization length (mean of 15 vs. 4 days), and charges ($367,801 vs. $63,726) [p<0.01]. After applying PS analysis and adjusting for comorbidities, age and gender did not affect survival. Although EMB is invasive, it seemed safe (not associated with increased mortality). (Figure 1) EMB was considered in very few selected critically ill patients admitted with myocarditis. EMB use was safe, although not associated with improved outcomes, most likely due to its limited use in the sicker population. Further studies are needed to determine the role of EMB in myocarditis patients. [ABSTRACT FROM AUTHOR]