Background: Gastrointestinal bleeding (GIB) is a common and serious complication in patients with left ventricular assist devices (LVADs), contributing to significant morbidity, prolonged hospitalization, and increased healthcare costs. We evaluated national trends, demographic disparities, and outcomes of GIB in hospitalized LVAD patients. Methods: We analyzed adult (≥18 years) LVAD hospitalizations in the National Inpatient Sample (2016–2021), identifying internal LVADs using ICD-10-PCS code 02HA0QZ. GIB was defined using ICD-10-CM codes and classified into upper (UGIB) and lower (LGIB) sources. Survey-weighted logistic and linear regression models assessed associations with mortality, length of stay (LOS), and total charges. Subgroup analyses explored sex and racial disparities. Results: Among 20,785 weighted adult LVAD admissions, 9.8% had GIB. Of these, 72.3% had LGIB and 31.0% had UGIB. Patients with GIB were older (59.2 vs. 54.8 years) and more likely to be female (43% vs. 40%) and Black (9.2% vs. 7.8%). GIB was associated with longer LOS (+15.3 days, 95% CI: 12.0–18.5), higher charges (+$316,031, 95% CI: $212,435–$419,627), and greater in-hospital mortality (OR 1.69, 95% CI: 1.25–2.29; p < 0.001). Female patients with GIB had higher odds of mortality (OR 1.37) and increased LOS (+5.6 days), though this was not statistically significant. Racial disparities were evident: Black patients with GIB had longer LOS (+8.9 days), while Asian/Pacific Islander patients had shorter LOS (–23.3 days, p < 0.001). From 2016 to 2021, GIB prevalence rose modestly (from 9.4% to 10.7%, p = 0.33), with no significant change in mortality trends (p = 0.13). Conclusions: GIB complicates nearly 1 in 10 LVAD hospitalizations, with lower GI bleeds being most common. GIB is independently associated with higher mortality, LOS, and costs. Persistent gender and racial disparities highlight the need for targeted strategies to improve outcomes in this high-risk population.

Cardiac amyloidosis (CA), including transthyretin (ATTR) and light-chain (AL) subtypes, is an underrecognized mimic of heart failure with preserved ejection fraction. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) benefit general heart failure (HF) populations, their role in CA is unclear. This study evaluated the impact of SGLT2i on outcomes in patients with CA. A systematic review and meta-analysis of seven observational studies (N = 13,303) compared patients with CA (AL and ATTR) receiving SGLT2i to matched controls. Outcomes included mortality, HF exacerbations, estimated GFR (eGFR), and NT-proBNP. Random-effects models were used to pool hazard ratios (HRs) and mean differences. In the primary analysis restricted to ATTR-CA, SGLT2i use was associated with lower observed all-cause mortality (the primary outcome; HR 0.71, 95% CI 0.58–0.87, p = 0.001). Among secondary outcomes in the ATTR-CA subgroup, SGLT2i use was associated with reduced NT-proBNP (−414 pg/mL, 95% CI –694 to −134, p = 0.004) and improved eGFR (+4.3 mL/min/1.73 m², 95% CI 1.4 to 7.2, p = 0.004). In a secondary, exploratory any-CA (AL + ATTR combined, 4 studies) analysis, the pooled mortality HR was 0.67 (95% CI 0.50–0.91, p = 0.010); between-study heterogeneity was substantial (I² = 75%), and this combined estimate should not be interpreted as a single class effect across CA subtypes. In this meta-analysis of non-randomized observational studies, SGLT2 inhibitor use was associated with lower observed mortality and improved cardiac biomarkers in CA, with renal benefits most evident in ATTR. Because all included studies were observational and susceptible to confounding by indication, immortal time bias, and survivor bias, these findings are hypothesis-generating and should not be interpreted as evidence of efficacy; randomized trials are needed before treatment recommendations can be made.