Abstract 11953: Predictors of In-Hospital Mortality Among Left Ventricular Assist Device Recipients in the United States: A National Inpatient Sample Perspective
Background: A remarkable increase in the rate of left ventricular assist devices (LVAD) placement has occurred in recent years. Despite increased utilization, there is a continued need to define the changing incidence of in-hospital mortality and their predictors.
Methods: From 2009 to 2011, National Inpatient Sample database was utilized to include all adult patients with admission diagnosis codes of congestive heart failure and procedure codes for left ventricular assist device (37.66). Patients who underwent LVAD and IABP or OHT placement were excluded from the analysis. Information about demographics, insurance, year of admission, and hospital characteristics, comorbidities and acute in hospital complications were abstracted. Using in-hospital death as our outcome, variables that achieved statistical significance (p <0.05) using Chi square testing were included in a multivariable regression analysis.
Results: A total of 4,869 patients had LVAD placement with a mean age was 56 (49-65) years. 57% of the patients were Caucasian and near half of the patients (46%) were on Medicare insurance. Ninety eight percent of the LVAD placement was performed in teaching hospitals. The overall mortality rate was 12.4%, with reduced mortality in 2010 and 2011 as compared to 2009. The presence of acute kidney injury (AKI) requiring hemodialysis (HD) was associated with the highest risk of in-hospital death [OR 21, CI 95% 14.4-30.8, p<0.001]. Other predictors of mortality included age, insurance status, end stage renal disease (ESRD), intubation and mechanical ventilation, pulmonary embolism, disseminated intravascular coagulopathy (DIC), severe liver disease and gastro-intestinal bleeding (GIB). Table 1
Conclusion: In this nationwide analysis, overall in-hospital mortality occurred in 12% of the patients following LVAD placement. The presence of older age, low socio-economic status, AKI, ESRD, GIB and DIC are associated with worse outcome following LVAD placement.
Author Disclosures: A.M. Mahmoud: None. A. Abbas: None. P. Draganov: None. J. Aranda: None. M. Ahmed: None.
- © 2015 by American Heart Association, Inc.