Abstract 12718: Ethnic Disparities in Outcomes After Left Ventricular Assist Device Implantation: An Analysis of National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiroki Ueyama ◽  
Aaqib H Malik ◽  
Toshiki Kuno ◽  
Yujiro Yokoyama ◽  
Suchith Shetty ◽  
...  

Introduction: Previous studies of patients undergoing various cardiac surgeries demonstrated worse outcomes among African American (AA) patients. It remains unclear if race is a predictor of outcomes among Left Ventricular Assist Device (LVAD) recipients. Methods: Patients who underwent LVAD implantation between 2010 and 2017 were identified using the national inpatient sample (NIS). Race was classified as Caucasians vs. AA vs. Hispanics, and endpoints were in-hospital outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models. Results: A total of 27,132 adults (5,114 unweighted) underwent LVAD implantation in the U.S. between 2010 and 2017, including Caucasians (63.8%), AA (23.8%) and Hispanics (6%). The number of LVAD implantations increased in both Caucasians and AA during the study period. AA LVAD recipients were younger, with higher rates of females and most of the comorbidities, but lower rates of coronary artery disease and coronary artery bypass grafting compared to Caucasians and Hispanics. Medicaid and median income at the lowest quartile were more frequent among AA LVAD recipients. We did not identify differences in in-hospital mortality, stroke, bleeding complications, infectious complications, and acute kidney injury requiring hemodialysis among racial groups (Table). AA LVAD recipients had lower rates of routine discharge than Caucasians and Hispanics, longer length of stay than Caucasians but similar cost of hospitalization. After adjustment with age gender and clinical comorbidities, race was not a predictor of in-hospital mortality. Conclusions: We identified differences in clinical characteristics but not in in-hospital complications among LVAD recipients of different race.

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Toshiki Kuno ◽  
Hiroki Ueyama ◽  
Suchith Shetty ◽  
Aaqib Malik ◽  
...  

Background: Valvular heart disease is common among Left Ventricular Assist Device (LVAD) recipients. However, its management at the time of LVAD implantation remains controversial. We sought to investigate and compare in-hospital outcomes of concomitant valvular surgery at the time of LVAD implantation. Methods: Patients who underwent LVAD implantation and concomitant aortic (AVR), mitral (MVR) or tricuspid valve (TVR) repair or replacement between 2010 and 2017 were identified using the national inpatient sample (NIS) in the US. Endpoints were in-hospital outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models. Results: A total of 25,171 weighted adults underwent LVAD implantation without valvular surgery, 1,329 had isolated TVR, 1,021 AVR, 377 MVR and 615 had combined valvular surgery (411 had TVR+AVR, 115 TVR+MVR, 62 AVR+MVR, 25 AVR+MVR+TVR). During the study period, rates of AVR decreased and combined valvular surgeries increased. Patients who underwent TVR had overall higher burden of comorbidities than LVAD recipients with or without other valvular procedures. Post-operative bleeding was more frequent among those who underwent AVR whereas acute kidney injury requiring dialysis was higher among those who underwent TVR or combined valvular surgery. In-hospital mortality was higher among those who underwent AVR, MVR or combined surgery without differences in the rates of stroke among groups (Table 1). Length of stay did not differ significantly among groups but cost of hospitalization and non-routine discharge rates were higher for cases of TVR and combined surgery. Conclusion: Approximately one in nine LVAD recipients underwent concomitant valvular surgery and TVR was the most frequently performed procedure. In-hospital mortality and cost were lower among those who did not undergo valvular surgery.


ASAIO Journal ◽  
2020 ◽  
Vol 66 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Priya Mehta ◽  
Teruhiko Imamura ◽  
Colleen Juricek ◽  
Nitasha Sarswat ◽  
Gene Kim ◽  
...  

2020 ◽  
Vol 9 (23) ◽  
Author(s):  
Joseph I. Wang ◽  
Daniel Y. Lu ◽  
MHS ◽  
Dmitriy N. Feldman ◽  
Stephen A. McCullough ◽  
...  

Background Cardiogenic shock (CS) is a complex syndrome associated with high morbidity and mortality. In recent years, many US hospitals have formed multidisciplinary shock teams capable of rapid diagnosis and triage. Because of preexisting collaborative systems of care, hospitals with left ventricular assist device (LVAD) programs may also represent “centers of excellence” for CS care. However, the outcomes of patients with CS at LVAD centers have not been previously evaluated. Methods and Results Patients with CS were identified in the 2012 to 2014 National Inpatient Sample. Clinical characteristics, revascularization rates, and use of mechanical circulatory support were analyzed in LVAD versus non‐LVAD centers. The association between hospital type and in‐hospital mortality was examined using multivariable logistic regression models. Of 272 075 hospitalizations, 26.0% were in LVAD centers. CS attributable to causes other than acute myocardial infarction represented most cases. In‐hospital mortality was lower in LVAD centers (38.9% versus 43.3%; P <0.001). In multivariable analysis, the odds of mortality remained significantly lower for hospitalizations in LVAD centers (odds ratio, 0.89; P <0.001). In patients with CS secondary to acute myocardial infarction, revascularization rates were similar between LVAD and non‐LVAD centers. The use of intra‐aortic balloon pump (18.7% versus 18.8%) and Impella/TandemHeart (2.6% versus 1.9%) was similar between hospital types, whereas extracorporeal membrane oxygenation was used more frequently in LVAD centers (4.3% versus 0.2%; P <0.001). Conclusions Risk‐adjusted mortality was lower in patients with CS who were hospitalized at LVAD centers. These centers likely represent specialized, shock team capable institutions across the country that may be best suited to manage patients with CS.


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