Shannon M Fernando1,2, Danial Qureshi3,4,5, Peter Tanuseputro3,4,5,6,7, Robert Talarico3,4, Benjamin Hibbert8, Rebecca Mathew9,8, Bram Rochwerg10,11, Emilie P Belley-Côté10,12,13, Eddy Fan14,15, Alain Combes16,17, Daniel Brodie18,19, Matthieu Schmidt16,17, Trevor Simard8, Pietro Di Santo8, Kwadwo Kyeremanteng9,4,7,20. 1. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. 2. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca. 3. ICES, Toronto, ON, Canada. 4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 5. Bruyère Research Institute, Ottawa, ON, Canada. 6. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 7. Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 8. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. 9. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 10. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada. 11. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 12. Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada. 13. Population Health Research Institute, Hamilton, ON, Canada. 14. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 15. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. 16. Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié Salpêtrière, Paris, France. 17. Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France. 18. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. 19. Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA. 20. Institut du Savoir Montfort, Ottawa, ON, Canada.
Abstract
PURPOSE: The Impella® device is a form of mechanical circulatory support (MCS) used in critically ill adults with cardiogenic shock. We sought to evaluate short- and long-term outcomes following the use of Impella, including mortality, healthcare utilization, and costs. METHODS: Population-based, retrospective cohort study of adult patients (≥ 16 yr) receiving Impella in Ontario, Canada (1 April 2012-31March 2019). We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization. Secondary outcomes included mortality at 30 days, 90 days, and one year following Impella insertion. We analyzed health system costs in Canadian dollars in the year following the date of the index admission, including the costs of inpatient admission. RESULTS: We included 162 patients. Mean (standard deviation) age was 59.2 (14.5) yr, and 73.5% of patients were male. Median [interquartile range (IQR)] time to Impella insertion from date of hospital admission was 2 [1-9] days. In-hospital mortality was 56.8%, and a significant proportion of patients were bridged to a ventricular assist device (67.9%). Mortality at one year was 61.7%. Among hospital survivors, only 38.6% were discharged home independently. Median [IQR] total cost in the year following admission among all patients was $88,397 [32,718-225,628], of which $66,529 [22,789-183,165] was attributed to inpatient care. CONCLUSIONS: In-hospital mortality among patients with cardiogenic shock receiving Impella is high, but with minimal increase at one year. While Impella patients accrued substantial costs, these largely reflected inpatient costs, and not costs incurred following hospital discharge.
PURPOSE: The Impella® device is a form of mechanical circulatory support (MCS) used in critically ill adults with cardiogenic shock. We sought to evaluate short- and long-term outcomes following the use of Impella, including mortality, healthcare utilization, and costs. METHODS: Population-based, retrospective cohort study of adult patients (≥ 16 yr) receiving Impella in Ontario, Canada (1 April 2012-31March 2019). We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization. Secondary outcomes included mortality at 30 days, 90 days, and one year following Impella insertion. We analyzed health system costs in Canadian dollars in the year following the date of the index admission, including the costs of inpatient admission. RESULTS: We included 162 patients. Mean (standard deviation) age was 59.2 (14.5) yr, and 73.5% of patients were male. Median [interquartile range (IQR)] time to Impella insertion from date of hospital admission was 2 [1-9] days. In-hospital mortality was 56.8%, and a significant proportion of patients were bridged to a ventricular assist device (67.9%). Mortality at one year was 61.7%. Among hospital survivors, only 38.6% were discharged home independently. Median [IQR] total cost in the year following admission among all patients was $88,397 [32,718-225,628], of which $66,529 [22,789-183,165] was attributed to inpatient care. CONCLUSIONS: In-hospital mortality among patients with cardiogenic shock receiving Impella is high, but with minimal increase at one year. While Impella patients accrued substantial costs, these largely reflected inpatient costs, and not costs incurred following hospital discharge.
Entities:
Keywords:
Impella; cardiogenic shock; health services; mechanical circulatory support
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