Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Abstract

The 2018 heart allocation system has significantly influenced heart transplantation and left ventricular assist device (LVAD) utilization. Our study aims to investigate age-related outcomes following LVAD implantation in the post-allocation era. Using the National Inpatient Sample, we analyzed data from 7375 patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by age categories. The age groups were 18–49, 50–59, 60–69, and over 70. These represented 26%, 26%, 31%, and 17% of patients, respectively. Patients aged 60–69 and those over 70 exhibited higher in-hospital mortality rates of 12% and 17%, respectively, compared to younger age groups (7% for 18–49 and 6% for 50–59). The age groups 60–69 and over 70 were independent predictors of mortality, with adjusted odds ratios of 1.99 (p = 0.02; 95% confidence interval [CI], 1.12–3.57) and 2.88 (p = 0.002; 95% CI, 1.45–5.71), respectively. Additionally, a higher Charlson Comorbidity Index was associated with increased in-hospital mortality risk (adjusted odds ratio 1.39; p = 0.02; 95% CI, 1.05–1.84). Additionally, patients above 70 experienced a statistically shorter length of stay. Nonhome discharge was found to be significantly high across all age categories. However, the difference in hospitalization cost was not statistically significant across the age groups. Our study highlights that patients aged 60 and above face an increased risk of in-hospital mortality following LVAD implantation in the post-allocation era. This study sheds light on age-related outcomes and emphasizes the importance of considering age in LVAD patient selection and management strategies.

The role of ventricular assist device in the management of advanced heart failure: a literature review

“…Finally, psychosocial factors like ongoing substance abuse, inability to provide informed consent, non-adherence to medical regimens, inability to maintain the VAD, and active mental illness or psychosocial instability also disqualify patients from VAD implantation (Feldman et al, 2013). Akkawi et al, 2024 suggested that patients aged 18-59 had lower in-hospital mortality rates (6-7%) compared to those aged 60-69 (12%) and over 70 (17%). Older patients faced higher risks due to more comorbidities, as indicated by the Charlson Comorbidity Index.…”

“…Age should be a key factor in LVAD patient selection and care. (Akkawi et al, 2024). Hemodynamic assessments are right heart catheterization, precise gauge cardiac pressures and output, and identifying individuals with severe hemodynamics is crucial.…”