Risky Business: Angiotensin II Use In A Heartmate 3 LVAD Patient In The Setting Of Refractory Vasoplegia
HFSA ePoster Library. Mathew C. 09/10/21; 343571; 329
Christo Mathew
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Abstract
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Introduction: From 2009-2014, total index hospitalizations and annual expenditures for heart transplantation (HT) and LVAD doubled, but more contemporary trends utilization and cost are not well understood.
Methods and Results: From 2015-2018, we identified 10,435 HT and 16,455 LVAD implantation index hospitalizations from the National Inpatient Sample. Hospitalizations for both increased over the study period, but less for LVAD (HT:2235 to 2955, LVAD: 3985 to 4045). For HT, length of stay (LOS) decreased but total costs and in-hospital mortality increased, (p<0.005, all). For LVAD implantation, LOS and inpatient mortality increased (both p<0.005) but total costs were stable. A higher percentage of HT admissions were discharged to home compared to those for LVAD implantation (Table 1). For both cohorts, admissions of Asian patients on Medicaid were the costliest (HT: median $361,068 [interquartile range (IQR) $165,938-595,240], LVAD: $459,419 [$270,332-583,858]). Those of Hispanic patients had the highest in-hospital mortality and longest LOS, all p<0.001. Women had longer median LOS for both, but lower in-hospital mortality in HT only, all p<0.014 (Table 2).
Conclusions: Hospitalization volume and in-hospital mortality increased for both, but LOS and totals costs varied for HT vs LVAD implantation. More work is needed to understand these disparities and post-discharge utilization and cost.
Methods and Results: From 2015-2018, we identified 10,435 HT and 16,455 LVAD implantation index hospitalizations from the National Inpatient Sample. Hospitalizations for both increased over the study period, but less for LVAD (HT:2235 to 2955, LVAD: 3985 to 4045). For HT, length of stay (LOS) decreased but total costs and in-hospital mortality increased, (p<0.005, all). For LVAD implantation, LOS and inpatient mortality increased (both p<0.005) but total costs were stable. A higher percentage of HT admissions were discharged to home compared to those for LVAD implantation (Table 1). For both cohorts, admissions of Asian patients on Medicaid were the costliest (HT: median $361,068 [interquartile range (IQR) $165,938-595,240], LVAD: $459,419 [$270,332-583,858]). Those of Hispanic patients had the highest in-hospital mortality and longest LOS, all p<0.001. Women had longer median LOS for both, but lower in-hospital mortality in HT only, all p<0.014 (Table 2).
Conclusions: Hospitalization volume and in-hospital mortality increased for both, but LOS and totals costs varied for HT vs LVAD implantation. More work is needed to understand these disparities and post-discharge utilization and cost.
Introduction: From 2009-2014, total index hospitalizations and annual expenditures for heart transplantation (HT) and LVAD doubled, but more contemporary trends utilization and cost are not well understood.
Methods and Results: From 2015-2018, we identified 10,435 HT and 16,455 LVAD implantation index hospitalizations from the National Inpatient Sample. Hospitalizations for both increased over the study period, but less for LVAD (HT:2235 to 2955, LVAD: 3985 to 4045). For HT, length of stay (LOS) decreased but total costs and in-hospital mortality increased, (p<0.005, all). For LVAD implantation, LOS and inpatient mortality increased (both p<0.005) but total costs were stable. A higher percentage of HT admissions were discharged to home compared to those for LVAD implantation (Table 1). For both cohorts, admissions of Asian patients on Medicaid were the costliest (HT: median $361,068 [interquartile range (IQR) $165,938-595,240], LVAD: $459,419 [$270,332-583,858]). Those of Hispanic patients had the highest in-hospital mortality and longest LOS, all p<0.001. Women had longer median LOS for both, but lower in-hospital mortality in HT only, all p<0.014 (Table 2).
Conclusions: Hospitalization volume and in-hospital mortality increased for both, but LOS and totals costs varied for HT vs LVAD implantation. More work is needed to understand these disparities and post-discharge utilization and cost.
Methods and Results: From 2015-2018, we identified 10,435 HT and 16,455 LVAD implantation index hospitalizations from the National Inpatient Sample. Hospitalizations for both increased over the study period, but less for LVAD (HT:2235 to 2955, LVAD: 3985 to 4045). For HT, length of stay (LOS) decreased but total costs and in-hospital mortality increased, (p<0.005, all). For LVAD implantation, LOS and inpatient mortality increased (both p<0.005) but total costs were stable. A higher percentage of HT admissions were discharged to home compared to those for LVAD implantation (Table 1). For both cohorts, admissions of Asian patients on Medicaid were the costliest (HT: median $361,068 [interquartile range (IQR) $165,938-595,240], LVAD: $459,419 [$270,332-583,858]). Those of Hispanic patients had the highest in-hospital mortality and longest LOS, all p<0.001. Women had longer median LOS for both, but lower in-hospital mortality in HT only, all p<0.014 (Table 2).
Conclusions: Hospitalization volume and in-hospital mortality increased for both, but LOS and totals costs varied for HT vs LVAD implantation. More work is needed to understand these disparities and post-discharge utilization and cost.
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