Robert Stretch1, Christopher M Sauer1, David D Yuh2, Pramod Bonde3. 1. Bonde Artificial Heart Laboratory, Yale University School of Medicine, New Haven, Connecticut. 2. Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut. 3. Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut; Center for Advanced Heart Failure and Transplantation, Yale University School of Medicine, New Haven, Connecticut. Electronic address: pramod.bonde@yale.edu.
Abstract
BACKGROUND: The number of alternatives to intra-aortic balloon counterpulsation in the treatment of anticipated and established acute circulatory failure is growing. Despite the clinical importance and significant cost of short-term mechanical circulatory support (MCS) devices, the state of their present use has not been analyzed on a national scale. OBJECTIVES: The purpose of this study was to characterize the demographics, treatment practices, survival rates, and cost of short-term MCS. METHODS: In this serial cross-sectional study, we analyzed all adult patients receiving short-term MCS in the United States from 2004 to 2011 by using the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. RESULTS: From 2007 to 2011, use of percutaneous devices for short-term MCS increased by 1,511% compared with a 101% increase in nonpercutaneous devices. Mortality rates declined over this period (p for trend = 0.027) from 41.1% in 2004 to 2007 to 33.4% in 2008 to 2011. A similar trend was observed for the subset of patients with cardiogenic shock, decreasing from 51.6% to 43.1% (p for trend = 0.012). Hospital costs also declined over this period (p for trend = 0.011). Multivariable analysis revealed balloon pumps (odds ratio [OR]: 2.00; 95% confidence interval [CI]: 1.58 to 2.52), coagulopathy (OR: 2.35; 95% CI: 1.88 to 2.94), and cardiopulmonary resuscitation (OR: 3.50; 95% CI: 2.20 to 5.57) before short-term MCS were among the most significant predictors of mortality. CONCLUSIONS: Use of short-term MCS in the United States has increased rapidly, whereas rates of in-hospital mortality have decreased. These changes have taken place in the context of declining hospital costs associated with short-term MCS.
BACKGROUND: The number of alternatives to intra-aortic balloon counterpulsation in the treatment of anticipated and established acute circulatory failure is growing. Despite the clinical importance and significant cost of short-term mechanical circulatory support (MCS) devices, the state of their present use has not been analyzed on a national scale. OBJECTIVES: The purpose of this study was to characterize the demographics, treatment practices, survival rates, and cost of short-term MCS. METHODS: In this serial cross-sectional study, we analyzed all adult patients receiving short-term MCS in the United States from 2004 to 2011 by using the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. RESULTS: From 2007 to 2011, use of percutaneous devices for short-term MCS increased by 1,511% compared with a 101% increase in nonpercutaneous devices. Mortality rates declined over this period (p for trend = 0.027) from 41.1% in 2004 to 2007 to 33.4% in 2008 to 2011. A similar trend was observed for the subset of patients with cardiogenic shock, decreasing from 51.6% to 43.1% (p for trend = 0.012). Hospital costs also declined over this period (p for trend = 0.011). Multivariable analysis revealed balloon pumps (odds ratio [OR]: 2.00; 95% confidence interval [CI]: 1.58 to 2.52), coagulopathy (OR: 2.35; 95% CI: 1.88 to 2.94), and cardiopulmonary resuscitation (OR: 3.50; 95% CI: 2.20 to 5.57) before short-term MCS were among the most significant predictors of mortality. CONCLUSIONS: Use of short-term MCS in the United States has increased rapidly, whereas rates of in-hospital mortality have decreased. These changes have taken place in the context of declining hospital costs associated with short-term MCS.
Authors: Jennifer Cowger; Palak Shah; John Stulak; Simon Maltais; Keith D Aaronson; James K Kirklin; Francis D Pagani; Christopher Salerno Journal: J Heart Lung Transplant Date: 2015-11-06 Impact factor: 10.247
Authors: Shiva K Annamalai; Michele L Esposito; Lara A Reyelt; Peter Natov; Lena E Jorde; Richard H Karas; Navin K Kapur Journal: Circ Heart Fail Date: 2018-08 Impact factor: 8.790