In-hospital mortality in older patients after ventricular assist device implantation: A national cohort study

Abstract

Objectives: To assess baseline patient characteristics and identify factors associated with in-hospital mortality after ventricular assist device (VAD) placement.Methods: Cross-sectional study using the National Inpatient Sample database from January 2010 to December 2014. Analyses were performed with sample weights provided by the National Inpatient Sample, which are reported AE the standard error of the mean.Results: Weighted samples yielded 15,021 AE 1111 patients who received a VAD. The mean age at time of implantation was 56.6 years. Most recipients were white (59.9%) and male (75.0%). Among older patients, in-hospital mortality increased from 17.2% to 48.2% when 1 or more high-risk interventions (cardiac surgery, prolonged mechanical ventilation, hemodialysis, or extracorporeal membrane oxygenation) preceded VAD placement (P < .001). In comparison, in-hospital mortality in younger patients increased from 11.1% to 29.4% when 1 or more of these same procedures preceded VAD placement. The mortality difference associated with these procedures was 19% greater in older patients compared with younger patients (95% confidence interval [CI], 9%-28%). In-hospital mortality among VAD recipients was associated with age older than 65 years (odds ratio [

Left Ventricular Assist Device Therapy in Older Adults: Addressing Common Clinical Questions

“…The effect of age on mortality following LVAD implantation is variable. One analysis of the National Inpatient Sample found that in‐hospital mortality among recipients of LVAD was associated with age older than 65 years (OR = 1.76), as was female sex (OR = 1.27) . Among older patients, in‐hospital mortality increased from 17.2% to 48.2% when one or more high‐risk interventions (prolonged mechanical ventilation, hemodialysis, cardiac surgery, or extracorporeal membrane oxygenation) were performed prior to LVAD placement .…”

“…One analysis of the National Inpatient Sample found that in‐hospital mortality among recipients of LVAD was associated with age older than 65 years (OR = 1.76), as was female sex (OR = 1.27) . Among older patients, in‐hospital mortality increased from 17.2% to 48.2% when one or more high‐risk interventions (prolonged mechanical ventilation, hemodialysis, cardiac surgery, or extracorporeal membrane oxygenation) were performed prior to LVAD placement . Atluri et al found that age older than 70 years was an independent predictor for death, with overall survival of 75% at 1 year, 63% at 2 years, and 54% at 3 years .…”

“…68 Among older patients, in-hospital mortality increased from 17.2% to 48.2% when one or more high-risk interventions (prolonged mechanical ventilation, hemodialysis, cardiac surgery, or extracorporeal membrane oxygenation) were performed prior to LVAD placement. 68 Atluri et al found that age older than 70 years was an independent predictor for death, with overall survival of 75% at 1 year, 63% at 2 years, and 54% at 3 years. 5 Other analyses have demonstrated similar post-LVAD survival at 2 years in those older than 65 years and younger patients.…”

Left ventricular assist devices in the elderly: Marching forward with cautions

“…It is well‐recognized that aging is a risk factor for mortality in LVAD recipients. Using the National Inpatient Sample database, Lindvall et al, showed that elderly LVAD recipients (age ≥65 years) had a 48.2% hospital mortality if they had one or more of the following pre‐LVAD therapies: cardiac surgery, extracorporeal membrane oxygenation, prolonged mechanical ventilation, or hemodialysis, while in younger (<65 years) patients the hospital mortality rate was 29.4% 6 . In another study, using the INTERMACS database to compare the outcomes of elderly (age ≥70 years) versus younger (age <70) recipients of CF‐LVAD implanted between June 2006 and April 2012, Atluri et al, reported that elderly patients had worse survival at 2 years than the younger ones (71% vs. 63%; p < .001) 7 .…”

Left Ventricular Assist Devices in The Elderly: Marching Forward With Cautions

“…65 years) had a 48.2% hospital mortality if they had one or more of the following pre-LVAD therapies: cardiac surgery, ECMO, prolonged mechanical ventilation, or hemodialysis, while in younger (<65 years) patients the hospital mortality rate was 29.4%. 5 In another study, using the INTERMACS database to compare the outcomes of elderly (age [?] 70 years) versus younger (age < 70) recipients of CF-LVAD implanted between June 2006 and April 2012, Atluri et al, reported that elderly patients had worse survival at 2 years than the younger ones (71% vs 63%, p < 0.001).…”