title: Trends in the use of percutaneous ventricular assist devices: analysis of national inpatient sample data, 2007 through 2012.
abstract: OBJECTIVE
  Percutaneous ventricular assist devices (PVADs) provide robust hemodynamic support compared with intra-aortic balloon pumps (IABPs), but clinical use patterns are unknown.
  
  
  OBJECTIVE
  To examine contemporary patterns in PVAD use in the United States and compare them with use of IABPs.
  
  
  METHODS
  Retrospective study of adults older than 18 years who received a PVAD or IABP while hospitalized in the United States (2007-2012).
  
  
  METHODS
  Temporal trends in utilization, patient and hospital characteristics, in-hospital mortality, and cost of PVAD use compared with IABP.
  
  
  RESULTS
  During 2007 through 2012, utilization of PVADs increased 30-fold (4.6 per million discharges in 2007 to 138 per million discharges in 2012; P for trend < .001) while utilization of IABPs decreased from 1738 per million discharges in 2008 to 1608 per million discharges in 2012 (P for trend = .02). In 2007, an estimated 72 hospitals used PVADs, increasing to 477 in 2011 (P for trend < .001). The number of hospitals with an annual volume of 10 or more PVAD procedures per year increased from 0 in 2007 to 102 in 2011 (21.4% of PVAD-using hospitals; P for trend < .001). Among PVAD recipients, 67.3% had a diagnosis of cardiogenic shock or acute myocardial infarction (AMI). There was a temporal increase in the use of PVADs in older patients and patients with AMI, hypertension, diabetes mellitus, and chronic kidney disease (P for trend < .001 for all). Overall, mortality in PVAD recipients was 28.8%, and mean (SE) hospitalization cost was $85,580 ($4165); both were significantly higher in PVAD recipients with cardiogenic shock (mortality, 47.5%; mean [SE] cost, $113,695 [$6260]; P < .001 for both). The PVAD recipients were less likely than IABP recipients to have cardiogenic shock (34.3% vs 41.2%; P = .001), AMI (48.0% vs 68.6%; P < .001), and undergo coronary artery bypass graft surgery (6.2% vs 43.2%; P < .001), but more likely to undergo percutaneous coronary intervention (70.9% vs 40.4%; P < .001). In propensity-matched analysis, PVADs were associated with higher mortality compared with IABP (odds ratio, 1.23 [95% CI, 1.06-1.43]; P = .007).
  
  
  CONCLUSIONS
  There has been a substantial increase in the use of PVADs in recent years with an accompanying decrease in the use of IABPs. Given the high mortality, associated cost, and uncertain evidence for a clear benefit, randomized clinical trials are needed to determine whether use of PVADs leads to improved patient outcomes.
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Rohan
authors.initials: R
authors.lastname: Khera
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada3Division of General Internal Medicine, University Health Network/Mt Sinai Hospitals, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.affiliation: Institute of Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Ankur
authors.initials: A
authors.lastname: Vyas
authors.affiliation: Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Alicia
authors.initials: A
authors.lastname: Gerke
authors.affiliation: Institute of Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City7Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Horwitz
authors.affiliation: Institute of Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City5Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Saket
authors.initials: S
authors.lastname: Girotra
mesh_terms: D000368:Aged; D005260:Female; D006353:Heart-Assist Devices / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012189:Retrospective Studies; D014481:United States
references.citation: JACC Heart Fail. 2013 Jun;1(3):200-6
references.pmid: 24621870
references.citation: Health Serv Res. 2014 Feb;49(1):284-303
references.pmid: 23855598
references.citation: BMJ. 1996 Apr 27;312(7038):1079
references.pmid: 8616417
references.citation: Eur Heart J. 2005 Jul;26(13):1276-83
references.pmid: 15734771
references.citation: Am Heart J. 2006 Sep;152(3):469.e1-8
references.pmid: 16923414
references.citation: Circulation. 2008 Feb 5;117(5):686-97
references.pmid: 18250279
references.citation: J Am Coll Cardiol. 2008 Nov 4;52(19):1584-8
references.pmid: 19007597
references.citation: JACC Cardiovasc Interv. 2009 Feb;2(2):91-6
references.pmid: 19463408
references.citation: Eur Heart J. 2009 Sep;30(17):2102-8
references.pmid: 19617601
references.citation: J Am Coll Cardiol. 2009 Dec 15;54(25):2430-4
references.pmid: 20082934
references.citation: N Engl J Med. 2010 Jun 10;362(23):2155-65
references.pmid: 20558366
references.citation: N Engl J Med. 2011 Sep 15;365(11):975-7
references.pmid: 21830959
references.citation: N Engl J Med. 2011 Sep 15;365(11):977-9
references.pmid: 21830961
references.citation: J Am Coll Cardiol. 2011 Dec 6;58(24):e44-122
references.pmid: 22070834
references.citation: Circulation. 2012 Apr 10;125(14):1809-17
references.pmid: 22492948
references.citation: Circulation. 2012 Oct 2;126(14):1717-27
references.pmid: 22935569
references.citation: N Engl J Med. 2012 Oct 4;367(14):1287-96
references.pmid: 22920912
references.citation: Circulation. 2013 Jan 15;127(2):207-12
references.pmid: 23224207
references.citation: Circulation. 2013 Jan 29;127(4):e362-425
references.pmid: 23247304
references.citation: Eur Heart J. 2014 Jan;35(3):156-67
references.pmid: 24014384