Abstract 16987: Utilization, Mortality and Length of Stay Associated With Left Ventricular Assist Device (LVAD) Implantation in Advanced Heart Failure Patients: A 13 Year Perspective
Background: LVAD is used either as destination therapy (DT) or bridge to transplant (BTT) in patients with advanced heart failure. We assessed the trends of LVAD use, mortality and length of stay using largest all payer database in US.
Methods: We queried the National Inpatient Sample (NIS) from 1998 to 2010 using ICD-9 procedure code of 37.66 for LVAD. Only patients >18 years without primary diagnosis of cardiogenic shock or acute myocardial infarction or heart transplant were included. Census data was used for population estimates to calculate utilization rate. Disposition was divided into 3 categories: discharge to home, discharge to other facility or in-hospital death. Chi square test for trend was used to examine difference in the time trends.
Results: A total of 2,025 procedures (weighted to US population n=10,251) were analyzed. Utilization rates of LVAD have significantly increased from 1.1 per million population (193 procedures) in 1998 to 9.8 per million population (2272 procedures) in 2010 (p<0.001). In-hospital mortality has decreased from 37.9% in 1998 to 13.3% in 2010 (p<0.001). Length of stay has declined from 48 + 46 days in 1998 to 30 + 18 days in 2010 (p<0.001). The proportion of home discharges has increased from 46.7% in 1998 to 68.5% in 2010 (p<0.001). In the year 2008, there has been a sharp increase in utilization of LVAD (2.9 per million population in 2007 to 5.2 per million population in 2008), decrease in in-hospital mortality (33.7% in 2007 to 14.9% in 2008) and increase in proportion of home discharges (51.1% in 2007 to 62.7% in 2008)
Conclusions: Our study shows significant increase in utilization, decline in in-hospital mortality and increase in proportion of home discharges after LVAD implantation across the US. National trends also coincide with US Food and Drug Administration approval of continuous flow LVAD as BTT in 2008.
- © 2013 by American Heart Association, Inc.