Original Investigation
National Trends in the Utilization of Short-Term Mechanical Circulatory Support: Incidence, Outcomes, and Cost Analysis

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Abstract

Background

The number of alternatives to intra-aortic balloon counterpulsation in the treatment of anticipated and established acute circulatory failure is growing. Despite the clinical importance and significant cost of short-term mechanical circulatory support (MCS) devices, the state of their present use has not been analyzed on a national scale.

Objectives

The purpose of this study was to characterize the demographics, treatment practices, survival rates, and cost of short-term MCS.

Methods

In this serial cross-sectional study, we 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.

Results

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 to 2.52), coagulopathy (OR: 2.35; 95% CI: 1.88 to 2.94), and cardiopulmonary resuscitation (OR: 3.50; 95% CI: 2.20 to 5.57) before short-term MCS were among the most significant predictors of mortality.

Conclusions

Use of short-term MCS in the United States has increased rapidly, whereas rates of in-hospital mortality have decreased. These changes have taken place in the context of declining hospital costs associated with short-term MCS.

Key Words

heart failure
left ventricular assist device
percutaneous devices
shock

Abbreviations and Acronyms

AMI
acute myocardial infarction
CAD
coronary artery disease and other heart disease
CCS
Clinical Classification Software
CHF
congestive heart failure
ECMO
extracorporeal membrane oxygenation
HCUP
Healthcare Cost and Utilization Project
HVD
heart valve disorder
IABP
intra-aortic balloon pump
LVAD
left ventricular assist device
MCS
mechanical circulatory support
PCI
percutaneous coronary intervention
PCPS
percutaneous cardiopulmonary support

Cited by (0)

This work was supported by the William W. Glenn Research Foundation, New Haven, Connecticut. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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