Abstract 11553: Decreasing Mortality of Ventricular Assist Devices at Children's Hospitals from 2000 to 2010: Improvement at a Cost
Introduction: The use of ventricular assist devices (VADs) has increased dramatically in adult heart failure patients. However, the overall use, outcome, and resource utilization of VADs in pediatric patients has not been well described. Hypothesis: The use of VADs in pediatric patients has increased over time and that mortality has decreased.
Methods: A retrospective study of the Pediatric Health Information System (PHIS) Database was performed for patients ≤ 20 years of age undergoing VAD placement from 2000 to 2010. The PHIS is a large administrative database of 43 participating children's hospitals across the United States.
Results: 475 VADs were placed during the study period: 69 in 2000-2003 (Era 1) and 271 2007-2010 (Era 2). The median age at VAD implantation was 6.0 years [interquartile (IQR) 0.5-13.8)], and the proportion of children aged 1-12 years increased from 29% in Era 1 to 47% in Era 2 (p=0.002). The majority of patients had a diagnosis of cardiomyopathy; this increased from 52% in Era 1 to 72% in Era 2 (p=0.003). Co-morbidities included arrhythmias (48%), pulmonary hypertension (16%), acute renal failure (ARF) (34%), and cerebrovascular disease (CVD) (28%). 247 (52%) underwent heart transplantation and 327 (69%) survived to hospital discharge. Hospital mortality decreased from 42% in Era 1 to 25% in Era 2 (p=0.004) which was accompanied by an increase in median hospital length of stay (LOS) [37 days (IQR 12-64) in Era 1 vs. 69 days (IQR 35-130) in Era 2 (p<0.001)] and adjusted hospital charges [$630,630 (IQR $227,052-$853,318) in Era 1 vs. $1,577,983 (IQR $874,463-$2,280,435) in Era 2 (p<0.001)]. Factors independently associated with increased mortality include infants (OR 2.04, 95% CI 1.01-3.83), ARF (OR 2.1, 95% CI 1.26-3.65), CVD 2.1 (95% CI 1.25-3.62), and the use of ECMO (OR 3.16, 95% CI 1.79-5.60). VAD placement in the Era 2 was independently associated with decreased mortality (OR 0.3, 95% CI 0.15-0.57).
Conclusions: The use of VADs and survival after VAD placement in pediatric patients has increased in the recent era. There has been a concomitant increase in resource utilization. Infants, non-cardiac morbidities, and the use of ECMO are associated with worse outcomes. Further study is needed to improve the care of this complex group of patients.
- © 2012 by American Heart Association, Inc.