title: Ventricular assist device implantation in the elderly: nationwide outcomes in the United States.
abstract: BACKGROUND
  The aim of this study was to evaluate nationwide outcomes of ventricular assist device (VAD) implantation in elderly patients in the United States.
  
  
  METHODS
  Patients undergoing VAD implantation between 2003 and 2008 were identified in the Nationwide Inpatient Sample. The primary outcome was inpatient mortality following VAD implantation. Secondary outcomes included disposition following discharge and costs of care. After stratification based on primary versus postcardiotomy VAD support, outcomes were compared between controls aged 60-69 years and elderly patients aged ≥70 years.
  
  
  RESULTS
  A total of 2787 patients aged 60-69 years and 1472 patients aged ≥70 years underwent VAD implantation during the study period. Unadjusted mortality rates were comparable between elderly and control patients in both primary support (35.7% vs. 32.1%, p = 0.61) and postcardiotomy support (58.1% vs. 56.1%, p = 0.70). Similarly, in risk-adjusted multivariable logistic regression analysis incorporating clinically relevant variables, age ≥70 did not exert an independent effect on inpatient mortality for either indication. Inpatient costs in the elderly were lower than controls in the primary support cohort, although costs per day were similar, with comparable overall costs between age groups in the postcardiotomy cohort. Elderly survivors were discharged to a facility more frequently than control survivors (primary: 49.9% vs. 29.6%, p = 0.007; postcardiotomy: 67.4% vs. 45.7%, p = 0.03).
  
  
  CONCLUSIONS
  This large-cohort population-based analysis provides a useful framework for inpatient prognosis and resource utilization in elderly patients undergoing VAD implantation. Although mortality rates and costs were found to be comparable between elderly patients and those aged 60-69 years, these rates were nonetheless significant. This combined with more frequent discharge-to-facility in elderly survivors underscores the importance of careful patient selection in this population.
authors: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
authors: Arman
authors: A
authors: Kilic
authors: Ibrahim
authors: I
authors: Sultan
authors: David D
authors: DD
authors: Yuh
authors: Ashish S
authors: AS
authors: Shah
authors: William A
authors: WA
authors: Baumgartner
authors: Duke E
authors: DE
authors: Cameron
authors: John V
authors: JV
authors: Conte
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D020379:Risk Adjustment; D016896:Treatment Outcome; D014481:United States