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

Abstract

To assess baseline patient characteristics and identify factors associated with in-hospital mortality after ventricular assist device (VAD) placement. 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 ± the standard error of the mean. Weighted samples yielded 15,021 ± 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 [OR], 1.76; 95% CI, 1.29-2.40), female sex (OR, 1.27; 95% CI, 0.97-1.67), and at least 1 high-risk intervention preceding VAD (OR, 5.52; 95% CI, 4.27-7.13). Older patients who underwent 1 or more intensive treatments before VAD placement had a nearly 50% inpatient mortality and were unlikely to receive a cardiac transplantation. Refining patient selection might help better align VAD with those most likely to benefit.