# In‐hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011−2019

## TL;DR

Unhoused patients with cardiogenic shock have similar mortality to housed patients but receive less aggressive treatments and more intubations.

## Contribution

This study provides the first insights into in-hospital outcomes and treatment disparities for unhoused patients with cardiogenic shock in the U.S.

## Key findings

- Unhoused patients with cardiogenic shock had lower odds of receiving invasive therapies like catheterization or mechanical support.
- Despite fewer comorbidities, unhoused patients had higher odds of intubation and infectious complications.
- Mortality rates were similar between unhoused and housed patients after adjusting for comorbidities.

## Abstract

Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in‐hospital outcomes and resource utilization in the setting of cardiogenic shock (CS).

Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients.

The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD‐9 and ICD‐10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in‐hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05).

We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints.

These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under‐diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long‐term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.

Unhoused patients hospitalized with cardiogenic shock (CS) have fewer traditional comorbidities however similar in‐hospital outcomes compared to housed patients.Unhoused patients with CS receive left and right heart catheterization and mechanical circulatory support less frequently than housed patients, however, undergo endotracheal intubation with greater frequency.A multidisciplinary approach along with strong community partnerships may result in improved access to care for this vulnerable population.

Unhoused patients hospitalized with cardiogenic shock (CS) have fewer traditional comorbidities however similar in‐hospital outcomes compared to housed patients.

Unhoused patients with CS receive left and right heart catheterization and mechanical circulatory support less frequently than housed patients, however, undergo endotracheal intubation with greater frequency.

A multidisciplinary approach along with strong community partnerships may result in improved access to care for this vulnerable population.