title: National Trends in Utilization, Mortality, Complications, and Cost of Care After Left Ventricular Assist Device Implantation From 2005 to 2011.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) have shown survival benefit in end-stage heart failure patients. LVAD technology has evolved considerably with the development of continuous-flow devices.
  
  
  METHODS
  The Nationwide Inpatient Sample was queried from 2005 to 2011 using International Classification of Diseases, 9th Edition procedure code 37.66, Insertion of Implantable Heart System, in any procedure field. Patients with primary diagnosis of orthotopic heart transplant or use of temporary mechanical circulatory support devices were excluded. Procedural complications were identified using International Classification of Diseases, 9th Edition codes and patient safety indicators. Cochran-Armitage and Cuzick tests for trend were used to identify time trends for categorical and continuous variables, respectively.
  
  
  RESULTS
  There were 2,038 LVAD implantations from 2005 to 2011. LVAD use increased from 127 procedures in 2005 to 506 procedures in 2011, and in-hospital mortality declined from 47.2% to 12.7% (p < 0.001), with sharp inflection points in the year 2008. Average length of stay decreased from 44 days in the pulsatile-flow era (2005 to 2007) to 36 days in the continuous-flow era (2008 to 2011). Cost of hospitalization increased from $194,380 in 2005 to $234,808 in 2011 but remained constant from 2008 to 2011. There was a trend of increased incidence of major bleeding and thromboembolism and decreased incidence of infectious and iatrogenic cardiac complications in the continuous-flow era.
  
  
  CONCLUSIONS
  LVAD use has increased and in-hospital mortality and LOS after LVAD implantation have declined. These changes coincide with United States Food and Drug Administration (FDA) approval of continuous-flow devices in 2008.
authors.affiliation: Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania. Electronic address: neerajshah86@gmail.com.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Cardiology, Staten Island University Hospital, New York, New York.
authors.forename: Vratika
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Department of Cardiology, University of Miami, Miami, Florida.
authors.forename: Nileshkumar
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Department of Cardiology, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Jalaj
authors.initials: J
authors.lastname: Garg
authors.affiliation: Department of Cardiology, Everett Clinic, Everett, Washington.
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.affiliation: Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Matthew
authors.initials: M
authors.lastname: Martinez
authors.affiliation: Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Nauman
authors.initials: N
authors.lastname: Islam
authors.affiliation: Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
authors.forename: Ronald
authors.initials: R
authors.lastname: Freudenberger
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011673:Pulsatile Flow / Q000502:physiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States