Abstract Body (Do not enter title and authors here): Introduction

Elevated homocysteine (HC) predisposes individuals to a prothrombotic state and may increase the risk of poor outcomes, including strokes and deep venous thrombosis (DVT). Previous studies did not find any mortality benefit after normalizing serum homocysteine levels. However, studies on the impact of HC on outcomes such as peripheral vascular disease (PVD) and chronic limb ischemia (CLI) in heart failure (HF) are lacking. We aimed to address this gap.

Methods

We examined the 2016 to 2021 Nationwide Inpatient Sample database and used the ICD-10 codes to identify the population with HF. We then stratified them into HC and non-HC groups. HC was defined as a composite of homocystinuria and methyltetrahydrofolate deficiency. Chi-square and Student T-test were used to compare continuous and categorical variables. A greedy neighbor 1:1 propensity score matching (PSM) followed by multivariable logistic regression models accounted for confounders and predicted the outcomes. Our primary outcomes were PVD and CLI, while secondary outcomes were ischemic stroke, pulmonary embolism (PE), and DVT.

Results
There were 3,415 HF hospitalizations with HC, with a mean age of 66.6 + 14.8, and 55.9% (1,910) were females.
After PSM, 1,420 HC hospitalizations were matched to 1,420 no-HC hospitalizations.
Compared to the non-HC group, there was no difference in PVD 1.15 (0.96-1.37) and CLI 0.66 (0.28-1.51), each p> 0.05.
However, ischemic stroke 3.3 (2.30-4.69), PE 6.3 (3.46-11.51), and DVT 3.6 (2.26-5.8) were significantly associated with the HC group, p<0.005, each.

Conclusions
Among the hospitalized population with heart failure, those with elevated homocysteine showed a higher association with ischemic stroke, DVT, and PE but no difference in peripheral vascular disease or chronic limb ischemia.