National Trends in the Utilization of Short-Term Mechanical Circulatory Support Incidence, Outcomes, and Cost Analysis
What are the demographics, treatment practices, survival rates, and costs of short-term mechanical circulatory support (MCS)?
In this serial cross-sectional study, the investigators analyzed all adult patients receiving short-term MCS in the United States from 2004 to 2011 by using the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. Multivariable logistic and linear regression was used to calculate the association among independent variables, in-hospital mortality, and the total cost of hospital stay.
From 2007 to 2011, use of percutaneous devices for short-term MCS increased by 1,511% compared with a 101% increase in nonpercutaneous devices. Mortality rates declined over this period (p for trend = 0.027), from 41.1% in 2004 to 2007, to 33.4% in 2008 to 2011. A similar trend was observed for the subset of patients with cardiogenic shock, decreasing from 51.6% to 43.1% (p for trend = 0.012). Hospital costs also declined over this period (p for trend = 0.011). Multivariable analysis revealed balloon pumps (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.58-2.52), coagulopathy (OR, 2.35; 95% CI, 1.88-2.94), and cardiopulmonary resuscitation (OR, 3.50; 95% CI, 2.20-5.57) before short-term MCS were among the most significant predictors of mortality.
The authors concluded that use of short-term MCS in the United States has increased rapidly, whereas rates of in-hospital mortality have decreased.
These observational data report that use of short-term MCS increased rapidly between 2007 and 2011, accompanied by declining rates of in-hospital mortality. Concomitant reductions in hospital costs were also observed during this period. It should be noted that it is difficult to differentiate and estimate the impact of short-term MCS evolution from other concurrent changes during the study period on mortality using the current study design, including efforts to reduce door-to-balloon times and length of inpatient stays. Only an adequately powered randomized study can definitely assess the true efficacy and safety of these MCS devices.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support
Keywords: Incidence, Shock, Cardiogenic, Hospital Costs, Hospital Mortality, Demography, Heart-Assist Devices, Survival Rate, Cardiopulmonary Resuscitation, Assisted Circulation, Blood Coagulation Disorders, United States, Length of Stay
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