Bridging The Ep & Hf Gap: A Dual Aprn Model Can Optimize Post-crt Management.
HFSA ePoster Library. Sprott K. 09/10/21; 343563; 321
Kimberly Sprott
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Abstract
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Introduction: The intra-aortic balloon pump (IABP) is the most utilized form of mechanical circulatory support (MCS) in the setting of cardiogenic shock (CS). However, there is a paucity of data pertaining to the timing of IABP implantation and its implications. This study investigated the in-hospital outcomes of early (≤3 days) versus late (>3 days) use of the IABP for patients with acute decompensated heart failure (ADHF) complicated by CS.
Methods: The National Inpatient Sample Database was queried from 2011 to 2018 for pertinent ICD-9 and ICD-10 codes to identify patients ≥18 years old with ADHF complicated by CS requiring IABP use. Statistical analyses included baseline comparisons and post procedure complications with the use of the Pearson Chi-square test for categorical variables and independent samples T-Testing for continuous variables between early and late use of the IABP.
Results: Between 2011 and 2018, a total of 9,671 IABPs were placed for MCS with early use (n=2,457, 25.4%) implanted ≤3 days and late use (n=7,214, 74.6%) implanted >3 days of hospitalization. Baseline characteristics are shown in Table 1. In the early IABP group, we found an increased incidence of inpatient mortality (25.6% vs 22.5%, p<0.001), however, a lower incidence of inpatient complications including acute kidney injury (59.4% vs 70.1%, p<0.001), major bleeding (11.4% vs 23.0%, p<0.001), and ventricular tachycardia (27.1% vs 37.9%, p<0.001). Using a multivariate logistic regression model, early IABP use was associated with increased odds of in-hospital mortality (odd ratio 1.67, 95% confidence interval 1.57-1.77, p<0.001) after adjusting for confounders including age, gender, race, diabetes, coronary artery disease and chronic kidney disease.
Conclusion: In our study, early IABP utilization was associated with increased inpatient mortality, yet less major complications. We postulate that these findings may be due to a higher disease acuity and/or worsened CS severity in the early IABP use group. Further studies evaluating IABP use as stratified by CS stage are needed.
Methods: The National Inpatient Sample Database was queried from 2011 to 2018 for pertinent ICD-9 and ICD-10 codes to identify patients ≥18 years old with ADHF complicated by CS requiring IABP use. Statistical analyses included baseline comparisons and post procedure complications with the use of the Pearson Chi-square test for categorical variables and independent samples T-Testing for continuous variables between early and late use of the IABP.
Results: Between 2011 and 2018, a total of 9,671 IABPs were placed for MCS with early use (n=2,457, 25.4%) implanted ≤3 days and late use (n=7,214, 74.6%) implanted >3 days of hospitalization. Baseline characteristics are shown in Table 1. In the early IABP group, we found an increased incidence of inpatient mortality (25.6% vs 22.5%, p<0.001), however, a lower incidence of inpatient complications including acute kidney injury (59.4% vs 70.1%, p<0.001), major bleeding (11.4% vs 23.0%, p<0.001), and ventricular tachycardia (27.1% vs 37.9%, p<0.001). Using a multivariate logistic regression model, early IABP use was associated with increased odds of in-hospital mortality (odd ratio 1.67, 95% confidence interval 1.57-1.77, p<0.001) after adjusting for confounders including age, gender, race, diabetes, coronary artery disease and chronic kidney disease.
Conclusion: In our study, early IABP utilization was associated with increased inpatient mortality, yet less major complications. We postulate that these findings may be due to a higher disease acuity and/or worsened CS severity in the early IABP use group. Further studies evaluating IABP use as stratified by CS stage are needed.
Introduction: The intra-aortic balloon pump (IABP) is the most utilized form of mechanical circulatory support (MCS) in the setting of cardiogenic shock (CS). However, there is a paucity of data pertaining to the timing of IABP implantation and its implications. This study investigated the in-hospital outcomes of early (≤3 days) versus late (>3 days) use of the IABP for patients with acute decompensated heart failure (ADHF) complicated by CS.
Methods: The National Inpatient Sample Database was queried from 2011 to 2018 for pertinent ICD-9 and ICD-10 codes to identify patients ≥18 years old with ADHF complicated by CS requiring IABP use. Statistical analyses included baseline comparisons and post procedure complications with the use of the Pearson Chi-square test for categorical variables and independent samples T-Testing for continuous variables between early and late use of the IABP.
Results: Between 2011 and 2018, a total of 9,671 IABPs were placed for MCS with early use (n=2,457, 25.4%) implanted ≤3 days and late use (n=7,214, 74.6%) implanted >3 days of hospitalization. Baseline characteristics are shown in Table 1. In the early IABP group, we found an increased incidence of inpatient mortality (25.6% vs 22.5%, p<0.001), however, a lower incidence of inpatient complications including acute kidney injury (59.4% vs 70.1%, p<0.001), major bleeding (11.4% vs 23.0%, p<0.001), and ventricular tachycardia (27.1% vs 37.9%, p<0.001). Using a multivariate logistic regression model, early IABP use was associated with increased odds of in-hospital mortality (odd ratio 1.67, 95% confidence interval 1.57-1.77, p<0.001) after adjusting for confounders including age, gender, race, diabetes, coronary artery disease and chronic kidney disease.
Conclusion: In our study, early IABP utilization was associated with increased inpatient mortality, yet less major complications. We postulate that these findings may be due to a higher disease acuity and/or worsened CS severity in the early IABP use group. Further studies evaluating IABP use as stratified by CS stage are needed.
Methods: The National Inpatient Sample Database was queried from 2011 to 2018 for pertinent ICD-9 and ICD-10 codes to identify patients ≥18 years old with ADHF complicated by CS requiring IABP use. Statistical analyses included baseline comparisons and post procedure complications with the use of the Pearson Chi-square test for categorical variables and independent samples T-Testing for continuous variables between early and late use of the IABP.
Results: Between 2011 and 2018, a total of 9,671 IABPs were placed for MCS with early use (n=2,457, 25.4%) implanted ≤3 days and late use (n=7,214, 74.6%) implanted >3 days of hospitalization. Baseline characteristics are shown in Table 1. In the early IABP group, we found an increased incidence of inpatient mortality (25.6% vs 22.5%, p<0.001), however, a lower incidence of inpatient complications including acute kidney injury (59.4% vs 70.1%, p<0.001), major bleeding (11.4% vs 23.0%, p<0.001), and ventricular tachycardia (27.1% vs 37.9%, p<0.001). Using a multivariate logistic regression model, early IABP use was associated with increased odds of in-hospital mortality (odd ratio 1.67, 95% confidence interval 1.57-1.77, p<0.001) after adjusting for confounders including age, gender, race, diabetes, coronary artery disease and chronic kidney disease.
Conclusion: In our study, early IABP utilization was associated with increased inpatient mortality, yet less major complications. We postulate that these findings may be due to a higher disease acuity and/or worsened CS severity in the early IABP use group. Further studies evaluating IABP use as stratified by CS stage are needed.
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