Charlotta Lindvall1, Brooks Udelsman2, Devvrat Malhotra3, Ethan Y Brovman4, Richard D Urman4, David A D'Alessandro5, James A Tulsky6. 1. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Mass; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass. Electronic address: Charlotta_Lindvall@DFCI.harvard.edu. 2. Department of Surgery, Massachusetts General Hospital, Boston, Mass. 3. Harvard School of Public Health, Boston, Mass. 4. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass. 5. Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass. 6. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Mass; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
Abstract
OBJECTIVES: To assess baseline patient characteristics and identify factors associated with in-hospital mortality after ventricular assist device (VAD) placement. METHODS: Cross-sectional study using the National Inpatient Sample database from January 2010 to December 2014. Analyses were performed with sample weights provided by the National Inpatient Sample, which are reported ± the standard error of the mean. RESULTS: Weighted samples yielded 15,021 ± 1111 patients who received a VAD. The mean age at time of implantation was 56.6 years. Most recipients were white (59.9%) and male (75.0%). Among older patients, in-hospital mortality increased from 17.2% to 48.2% when 1 or more high-risk interventions (cardiac surgery, prolonged mechanical ventilation, hemodialysis, or extracorporeal membrane oxygenation) preceded VAD placement (P < .001). In comparison, in-hospital mortality in younger patients increased from 11.1% to 29.4% when 1 or more of these same procedures preceded VAD placement. The mortality difference associated with these procedures was 19% greater in older patients compared with younger patients (95% confidence interval [CI], 9%-28%). In-hospital mortality among VAD recipients was associated with age older than 65 years (odds ratio [OR], 1.76; 95% CI, 1.29-2.40), female sex (OR, 1.27; 95% CI, 0.97-1.67), and at least 1 high-risk intervention preceding VAD (OR, 5.52; 95% CI, 4.27-7.13). CONCLUSIONS: Older patients who underwent 1 or more intensive treatments before VAD placement had a nearly 50% inpatient mortality and were unlikely to receive a cardiac transplantation. Refining patient selection might help better align VAD with those most likely to benefit.
OBJECTIVES: To assess baseline patient characteristics and identify factors associated with in-hospital mortality after ventricular assist device (VAD) placement. METHODS: Cross-sectional study using the National Inpatient Sample database from January 2010 to December 2014. Analyses were performed with sample weights provided by the National Inpatient Sample, which are reported ± the standard error of the mean. RESULTS: Weighted samples yielded 15,021 ± 1111 patients who received a VAD. The mean age at time of implantation was 56.6 years. Most recipients were white (59.9%) and male (75.0%). Among older patients, in-hospital mortality increased from 17.2% to 48.2% when 1 or more high-risk interventions (cardiac surgery, prolonged mechanical ventilation, hemodialysis, or extracorporeal membrane oxygenation) preceded VAD placement (P < .001). In comparison, in-hospital mortality in younger patients increased from 11.1% to 29.4% when 1 or more of these same procedures preceded VAD placement. The mortality difference associated with these procedures was 19% greater in older patients compared with younger patients (95% confidence interval [CI], 9%-28%). In-hospital mortality among VAD recipients was associated with age older than 65 years (odds ratio [OR], 1.76; 95% CI, 1.29-2.40), female sex (OR, 1.27; 95% CI, 0.97-1.67), and at least 1 high-risk intervention preceding VAD (OR, 5.52; 95% CI, 4.27-7.13). CONCLUSIONS: Older patients who underwent 1 or more intensive treatments before VAD placement had a nearly 50% inpatient mortality and were unlikely to receive a cardiac transplantation. Refining patient selection might help better align VAD with those most likely to benefit.
Authors: Caress A Dean; Diana Zhang; Kevin T Kulchycki; Brittany Ventline; Rachita Jagirdar; Rebecca A Milan Journal: J Racial Ethn Health Disparities Date: 2019-11-11