Economic and Operational Implications of a Standardized Approach to Hemodynamic Support Therapy Using Percutaneous Cardiac Assist Devices

2014 ◽  
Vol 9 (1) ◽  
pp. 38-42 ◽  
Author(s):  
David Wohns ◽  
Purushothaman Muthusamy ◽  
Alan T. Davis ◽  
Mohsin Khan ◽  
Joseph K. Postma ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Resource Use ◽  
Length Of Hospital Stay ◽  
Coronary Intervention ◽  
Resource Consumption ◽  
Cardiac Assist ◽  
Hemodynamic Support ◽  
Episode Of Care ◽  
Cardiac Assist Devices

Objective Impella 2.5 has been shown to reduce major adverse events for patients undergoing elective high-risk percutaneous coronary intervention. We performed a single-center retrospective study to compare the costs and resource use of Impella 2.5 and intra-aortic balloon pump (IABP) support. Methods All high-risk patients who received Impella 2.5 (n = 35) and IABP (n = 295) support from December 2008 to July 2011 were included. Propensity score matching identified a balanced 1:1 matched cohort (35 Impella vs 35 IABP) based on indications for implantation, preimplantation hemodynamics, and age. Diagnostic, procedural, financial, and resource use data were collected. Results As compared with IABP, Impella offered a more predictable course of treatment/resource consumption and was not associated with any extreme cost outliers (17.1% vs 0.0%, respectively; P = 0.025). The mean admission and 90-day episode of care total costs for Impella were 5.5% ($67,681 vs $71,608, P = 0.79) and 4.2% ($70,680 vs $73,476, P = 0.85) lesser than that for IABP, respectively. Although not statistically significant, Impella patients had a trend toward lower rehospitalization rates (11.4% vs 20%), lesser mean index length of hospital stay (11.2 vs 13.7), and 90-day (11.7 vs 14.2) episode of care length of hospital stay. Conclusions Impella support was associated with consistent course of treatment/resource consumption with significantly fewer 90-day extreme cost outliers than was IABP. The lower index and 90-day follow-up cost trends observed for Impella were driven by shorter length of hospital stay and fewer rehospitalizations. As providers strive to improve quality of care by reducing variability, these findings have implications for the development of hemodynamic support algorithms.

scholarly journals The Role of Percutaneous Haemodynamic Support in High-risk Percutaneous Coronary Intervention and Cardiogenic Shock

2015 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Dagmar M Ouweneel ◽  
Bimmer E Claessen ◽  
Krischan D Sjauw ◽  
José PS Henriques ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Coronary Intervention ◽  
Assist Devices ◽  
Cardiac Assist ◽  
Cardiac Assist Devices ◽  
Percutaneous Coronary ◽  
Haemodynamic Improvement

The experience and usage of percutaneous cardiac assist devices in cardiogenic shock as well as high-risk percutaneous coronary intervention have increased over the years. Nonetheless, there is still little evidence of clinical benefit of these devices other than immediate haemodynamic improvement. Despite the fact that these devices are used to treat a rather complex patient population, clinical testing remains important in order to evaluate their true impact on clinical outcome before being adopted into clinical practice. Therefore, this review shows an overview of the current experience and evidence of the available percutaneous cardiac assist devices.

scholarly journals Intervenção percutânea por via radial e tempo de permanência hospitalar

2018 ◽  
Vol 12 (6) ◽  
pp. 1665
Author(s):  
Denise Viana Rodrigues de Oliveira ◽  
João Pimenta ◽  
George Ximenes ◽  
Agueda Maria Ruiz Zimmer Cavalcante
Keyword(s):  
Health System ◽  
Hospital Stay ◽  
Pearson Correlation ◽  
Length Of Hospital Stay ◽  
Coronary Intervention ◽  
Study Data ◽  
Significance Level ◽  
Coronary Syndrome ◽  
Unified Health System ◽  
Factores De Riesgo

RESUMOObjetivo: analisar os fatores de risco relacionados ao procedimento percutâneo por via radial e o tempo de permanência hospitalar. Método: estudo quantitativo, longitudinal, prospectivo, descritivo e unicêntrico. A coleta de dados foi realizada por meio de questionário, com 100 pacientes, em três fases (pré-procedimento, transprocedimento e pós-procedimento), em 24h e após sete dias. Para as variáveis quantitativas, foram utilizados os testes Mann-Whitnney ou t de Student; para as qualitativas, o teste exato de Fisher. Para a associação entre duas variáveis quantitativas, foi utilizado o coeficiente de correlação de Pearson com nível de significância ≤5%. Resultados: 100 pacientes realizaram o procedimento com média de internação de 6,6 dias. Após a associação entre o tempo de permanência e as variáveis clínicas, o p não mostrou valor significante. Conclusão: os resultados aproximam-se mais da realidade dos hospitais do Sistema Único de Saúde; não houve linearidade no tempo de permanência hospitalar quando associado a diferentes fatores relacionados à intervenção percutânea. Descritores: Intervenção Coronária Percutânea; Tempo de Internação; Artéria Radial; Sistema Único de Saúde; Síndrome Coronária Aguda; Fatores de Risco.ABSTRACTObjective: to analyze the risk factors related to the percutaneous radial procedure and length of hospital stay. Method: quantitative, longitudinal, prospective, descriptive and unicentric study. Data was collected through a questionnaire, with 100 patients, in three phases (pre-procedure, transprocedure and post-procedure), in 24 hours and after seven days. For the quantitative variables, the Mann-Whitnney or Student's t tests were used; for the qualitative, Fisher's exact test. For the association between two quantitative variables, the Pearson correlation coefficient was used with significance level ≤5%. Results: 100 patients had the procedure with mean hospitalization of 6.6 days. After the association between the length of stay and clinical variables, p did not show significant value. Conclusion: the results are closer to the reality of the hospitals of the Unified Health System; there was no linearity in the length of hospital stay when associated with different factors related to the percutaneous intervention. Descriptors: Percutaneous Coronary Intervention; Length of hospitalization; Radial Artery; Unified Health System; Acute Coronary Syndrome; Risk Factors.RESUMEN Objetivo: analizar los factores de riesgo relacionados con el procedimiento percutáneo por vía radial y el tiempo de permanencia hospitalaria. Método: Estudio cuantitativo, longitudinal, prospectivo, descriptivo y unicéntrico. La recolección de datos fue realizada por medio de un cuestionario, con 100 pacientes, en tres fases: (pre-procedimiento, transprocedimiento y post-procedimiento), en 24h y después de siete días. Para las variables cuantitativas, se utilizaron las pruebas Mann-Whitnney o t de Student; para las cualitativas, la prueba exacta de Fisher. Para la asociación entre dos variables cuantitativas, se utilizó el coeficiente de correlación de Pearson con nivel de significancia ≤5 %%. Resultados: 100 pacientes realizaron el procedimiento, con promedio de internación de 6,6 días. Después de la asociación entre el tiempo de permanencia y las variables clínicas, el p no mostró valor significativo. Conclusión: los resultados se acercaron más a la realidad de los hospitales del Sistema Único de Salud; no hubo linealidad en el tiempo de permanencia hospitalaria, cuando asociado a diferentes factores relacionados a la intervención percutánea. Descriptores: Intervención Coronaria Percutánea; Tiempo de Internación; Arteria Radial; Sistema Único de Salud; Síndrome Coronária Aguda; Factores de Riesgo.

Use of the Impella 2.5 in High-Risk Percutaneous Coronary Intervention

2011 ◽  
Vol 31 (1) ◽  
pp. e1-e16 ◽  
Author(s):  
Brenda McCulloch
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Interventional Procedures ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Coronary Intervention ◽  
Assist Device ◽  
Hemodynamic Support ◽  
Multidisciplinary Program ◽  
Percutaneous Coronary

The Impella 2.5 is a percutaneously placed partial circulatory assist device that is increasingly being used in high-risk coronary interventional procedures to provide hemodynamic support. The Impella 2.5 is able to unload the left ventricle rapidly and effectively and increase cardiac output more than an intra-aortic balloon catheter can. Potential complications include bleeding, limb ischemia, hemolysis, and infection. One community hospital’s approach to establishing a multidisciplinary program for use of the Impella 2.5 is described.

Goal-Directed Intraoperative Therapy Reduces Morbidity and Length of Hospital Stay in High-Risk Surgical Patients

CHEST Journal ◽  
2007 ◽  
Vol 132 (6) ◽  
pp. 1817-1824 ◽  
Author(s):  
Abele Donati ◽  
Silvia Loggi ◽  
Jean-Charles Preiser ◽  
Giovanni Orsetti ◽  
Cristopher Münch ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Surgical Patients

scholarly journals Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study (Preprint)

2020 ◽  
Author(s):  
Sung-Yeon Cho ◽  
Sung-Soo Park ◽  
Min-Kyu Song ◽  
Young Yi Bae ◽  
Dong-Gun Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
High Risk ◽  
Hospital Stay ◽  
Risk Score ◽  
Validation Cohort ◽  
Length Of Hospital Stay ◽  
Risk Groups ◽  
Prognosis Score ◽  
Very High

BACKGROUND As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. OBJECTIVE In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. METHODS We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. RESULTS Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count &lt;1000/mm<sup>3</sup>. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (<i>P</i>&lt;.001). The length of hospital stay and disease severity were directly associated with overall survival (<i>P</i>&lt;.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). CONCLUSIONS The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic.

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