Among adults hospitalized with acute myocarditis, all racial and ethnic minority groups had higher adjusted odds of in-hospital mortality than White patients, with distinct patterns of complications across groups.
Key Findings
Results
All racial and ethnic minority groups had significantly higher adjusted odds of in-hospital mortality compared to White patients with acute myocarditis.
Black patients: aOR 1.30 (95% CI 1.10–1.55)
Hispanic patients: aOR 1.37 (95% CI 1.14–1.66)
Asian/Pacific Islander patients: aOR 2.07 (95% CI 1.58–2.72)
'Other' race/ethnicity patients: aOR 1.40 (95% CI 1.07–1.83)
Analysis used multivariable logistic regression with adjusted odds ratios from the National Inpatient Sample (NIS) 2012–2021
Results
Asian/Pacific Islander patients had the highest odds of cardiogenic shock and mechanical circulatory support use among all racial/ethnic groups.
Asian/Pacific Islander patients also had the highest in-hospital mortality odds (aOR 2.07) of any minority group
Mechanical circulatory support (MCS) was a secondary outcome measured via multivariable logistic regression
Cardiogenic shock was also a prespecified secondary outcome
The elevated MCS use suggests more severe hemodynamic compromise in this group
Results
Black patients had higher odds of cardiac arrest and ventricular tachycardia/fibrillation (VT/VF) compared to White patients.
Cardiac arrest and VT/VF were prespecified secondary outcomes
Black patients had an aOR of 1.30 for in-hospital mortality
These arrhythmic complications represent a distinct pattern of disease expression in Black patients compared to other minority groups
Analysis was conducted using the NIS, a nationally representative database, over a 10-year period (2012–2021)
Results
Hispanic patients had higher in-hospital mortality despite lower odds of VT/VF and mechanical circulatory support use.
Hispanic patients had an aOR of 1.37 (95% CI 1.14–1.66) for in-hospital mortality
Lower odds of VT/VF and MCS use in Hispanic patients compared to other minority groups suggest the mortality disparity may be driven by factors other than severe arrhythmia or hemodynamic failure requiring support
This paradox highlights potentially distinct pathways to adverse outcomes in Hispanic patients
Secondary outcomes included cardiogenic shock, MCS, cardiac arrest, VT/VF, acute kidney injury, renal replacement therapy, and stroke
Results
The interaction between race/ethnicity and pandemic era for in-hospital mortality was not statistically significant.
Interaction p-value = 0.072 for race/ethnicity by pandemic era for mortality
The study period spanned 2012–2021, encompassing both pre-pandemic and COVID-19 pandemic years
This suggests that racial/ethnic disparities in acute myocarditis mortality were not significantly modified by the COVID-19 pandemic period
Methods
The study identified 105,235 weighted hospitalizations with a primary diagnosis of acute myocarditis using the National Inpatient Sample from 2012 to 2021.
The National Inpatient Sample (NIS) is a nationally representative database of inpatient hospitalizations in the United States
Only adult hospitalizations with a primary diagnosis of acute myocarditis were included
The primary outcome was all-cause in-hospital mortality
Secondary outcomes included cardiogenic shock, MCS, cardiac arrest, VT/VF, acute kidney injury, renal replacement therapy, and stroke
The 10-year study period (2012–2021) allowed for examination of trends across both pre-pandemic and pandemic eras
What This Means
This research suggests that when people of different racial and ethnic backgrounds are hospitalized for a heart condition called acute myocarditis (inflammation of the heart muscle), those from racial and ethnic minority groups are more likely to die in the hospital than White patients, even after accounting for other differences between patients. Using a large national database covering over 105,000 hospital stays between 2012 and 2021, the researchers found that Asian/Pacific Islander patients faced the highest risk of dying (about twice the odds of White patients), while Black, Hispanic, and patients of other racial/ethnic backgrounds also had significantly elevated risks ranging from 30% to 40% higher odds of death.
The study also found that different groups experienced different types of serious complications. Asian/Pacific Islander patients were more likely to go into cardiogenic shock (when the heart suddenly cannot pump enough blood) and to need mechanical devices to support heart function. Black patients were more likely to experience dangerous heart rhythm problems, including cardiac arrest. Hispanic patients had higher death rates despite not showing the same elevated rates of these specific severe complications, suggesting their higher mortality may be driven by other factors not fully captured in this analysis.
This research matters because it shows that racial and ethnic disparities in heart disease outcomes extend to acute myocarditis, a condition that can affect younger and otherwise healthy people. The distinct patterns of complications seen across racial and ethnic groups suggest that a one-size-fits-all approach to care may not be sufficient, and that clinicians should be aware of these differing risk profiles. The findings highlight an ongoing need to understand why these disparities exist — whether due to differences in healthcare access, quality of care, underlying biology, or social determinants of health — in order to work toward more equitable outcomes for all patients.
Osorio M, Lecompte-Osorio P, Vasquez-Ariza S, Dangl M, Vincent L, Contreras J, et al.. (2026). Racial and Ethnic Disparities in Acute Myocarditis Outcomes in the United States.. Clinical cardiology. https://doi.org/10.1002/clc.70460