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In patients hospitalized for thyroid storm, any cardiovascular event is associated with a longer hospital stay, higher costs, and higher mortality.

That's according to findings published in the .

Researchers analyzed a total of 6,380 adult hospitalizations for thyroid storm, with 3,895 including cardiovascular events. The most frequent cardiovascular events were arrhythmia (N=3,770), followed by acute heart failure (N=555), and ischemic events (N=150). Inpatient mortality was significantly higher for those in the study who sustained cardiovascular events compared with those who did not (3.5% vs 0.2%, P<0.005).

The study was led by a team of Ohio-based researchers and Zainulabedin Waqar, MD, a physician researcher with St. Vincent Mercy Hospital in Toledo, served as first author. The following excerpts have been edited for length and clarity.

Why was it important to study cardiovascular events in people with thyroid storm?

Thyroid storm occurs most commonly in people with Grave's disease or toxic multinodular goiter. More rarely, it can develop from subacute thyroiditis caused by thyroid hormone overdose.

Thyroid storm has a mortality rate as high as 30%. Its incidence is 4.8-5.6 per 100,000 hospitalized patients per year. It has also been reported to occur in 16% of patients hospitalized with thyrotoxicosis and is 12 times more lethal than thyrotoxicosis without storm.

This retrospective analysis attempted to define characteristics of patients hospitalized with thyroid storm and assess the impact the cardiovascular events can have on outcomes.

What differences emerged between inpatients in the study who did and did not sustain adverse cardiovascular events?

Many of the differences between those who did and did not sustain cardiovascular events were based in large part on familiar risk factors.

For example, those with thyroid storm who were obese or had COPD were more likely to experience cardiovascular events (obesity 6.9% vs 5.3%, P=0.005; COPD 16.3% vs 13.5%, P=0.0014). Chronic liver disease also was present in a greater proportion of patients with cardiovascular events (2.6% vs 1.7%; P=0.02). Moreover, smokers were more likely to have cardiovascular events (35.2% vs 32.2%, P=0.01).

No significant differences emerged for patients with hypertension, diabetes, or chronic renal disease.

Hospital length of stay was, on average, a full day longer for those who had a cardiovascular event (4 [CI 2-7] vs 3 [CI 2-5]. Median costs also were considerably higher for this group ($7,744 [CI $4,581-$14,674] vs $5,380 [CI $3,435-$8,641]).

Were there any differences along demographic or socioeconomic lines?

More white patients were diagnosed with cardiovascular events than those who were not white (41.1% vs 37.5%). Among Black patients, a smaller percentage had a cardiovascular event (32.1% vs 34.8%).

The American south had higher percentages of patients in the lowest quartile and overall number of patients treated (45.3% of all patients with no cardiovascular events and 45.7% of total patients with cardiovascular events).

No significant differences emerged based on median patient income or the location of the hospital.

What are the key clinical and/or research takeaways from these findings?

People with thyroid storm coupled with obesity, alcohol abuse, chronic liver disease, and/or COPD are at higher risk for cardiovascular events and death. Clinicians should be aware of these risk factors in patients who are admitted to the hospital with thyroid storm.

Further evaluation is needed to further explore the phenomenon based on type of arrhythmia and associated mortality.

Read the study here and expert commentary on the clinical implications here.