. 2020 Dec;67(12):1728-1737.

doi: 10.1007/s12630-020-01755-9. Epub 2020 Jul 15.

Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort study

Shannon M Fernando^{1

2}, Danial Qureshi^{3

4

5}, Peter Tanuseputro^{3

4

5

6

7}, Robert Talarico^{3

4}, Benjamin Hibbert⁸, Rebecca Mathew^{9

8}, Bram Rochwerg^{10

11}, Emilie P Belley-Côté^{10

12

13}, Eddy Fan^{14

15}, Alain Combes^{16

17}, Daniel Brodie^{18

19}, Matthieu Schmidt^{16

17}, Trevor Simard⁸, Pietro Di Santo⁸, Kwadwo Kyeremanteng^{9

4

7

20}

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.
² Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.
³ ICES, Toronto, ON, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Bruyère Research Institute, Ottawa, ON, Canada.
⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁷ Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
⁹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
¹¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
¹² Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹³ Population Health Research Institute, Hamilton, ON, Canada.
¹⁴ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹⁵ Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
¹⁶ Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié Salpêtrière, Paris, France.
¹⁷ Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.
¹⁸ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
¹⁹ Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
²⁰ Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 32671805
DOI: 10.1007/s12630-020-01755-9

Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort study

Shannon M Fernando et al. Can J Anaesth. 2020 Dec.

. 2020 Dec;67(12):1728-1737.

doi: 10.1007/s12630-020-01755-9. Epub 2020 Jul 15.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.
² Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.
³ ICES, Toronto, ON, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Bruyère Research Institute, Ottawa, ON, Canada.
⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁷ Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
⁹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
¹¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
¹² Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹³ Population Health Research Institute, Hamilton, ON, Canada.
¹⁴ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹⁵ Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
¹⁶ Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié Salpêtrière, Paris, France.
¹⁷ Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.
¹⁸ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
¹⁹ Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA.
²⁰ Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 32671805
DOI: 10.1007/s12630-020-01755-9

Abstract
in English, French

Purpose: The Impella® device is a form of mechanical circulatory support (MCS) used in critically ill adults with cardiogenic shock. We sought to evaluate short- and long-term outcomes following the use of Impella, including mortality, healthcare utilization, and costs.

Methods: Population-based, retrospective cohort study of adult patients (≥ 16 yr) receiving Impella in Ontario, Canada (1 April 2012-31March 2019). We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization. Secondary outcomes included mortality at 30 days, 90 days, and one year following Impella insertion. We analyzed health system costs in Canadian dollars in the year following the date of the index admission, including the costs of inpatient admission.

Results: We included 162 patients. Mean (standard deviation) age was 59.2 (14.5) yr, and 73.5% of patients were male. Median [interquartile range (IQR)] time to Impella insertion from date of hospital admission was 2 [1-9] days. In-hospital mortality was 56.8%, and a significant proportion of patients were bridged to a ventricular assist device (67.9%). Mortality at one year was 61.7%. Among hospital survivors, only 38.6% were discharged home independently. Median [IQR] total cost in the year following admission among all patients was $88,397 [32,718-225,628], of which $66,529 [22,789-183,165] was attributed to inpatient care.

Conclusions: In-hospital mortality among patients with cardiogenic shock receiving Impella is high, but with minimal increase at one year. While Impella patients accrued substantial costs, these largely reflected inpatient costs, and not costs incurred following hospital discharge.

RéSUMé: OBJECTIF: Le dispositif Impella® est un système d’assistance circulatoire mécanique utilisé chez les adultes en état critique souffrant d’un choc cardiogénique. Nous avons souhaité évaluer les issues à court et à long terme liées à l’utilisation de l’Impella, notamment la mortalité, l’utilisation des soins de santé et les coûts. MéTHODE: Nous avons réalisé une étude de cohorte rétrospective basée sur une population de patients adultes (≥ 16 ans) recevant un Impella en Ontario, au Canada (1^er avril 2012–31 mars 2019). Nous avons saisi les données pertinentes à nos critères d’évaluation en créant des liens avec les bases de données administratives de santé. Le critère d’évaluation principal était la mortalité pendant l’hospitalisation. Les critères d’évaluation secondaires comportaient la mortalité à 30 jours, 90 jours et un an après l’insertion de l’Impella. Nous avons analysé les coûts pour le système de santé en dollars canadiens au cours de l’année suivant la date d’admission initiale, notamment les coûts hospitaliers. RéSULTATS: Nous avons inclus 162 patients. L’âge moyen (écart type) était de 59,2 (14,5) ans, et 73,5 % des patients étaient des hommes. Le temps médian [écart interquartile (ÉIQ)] jusqu’à insertion de l’Impella depuis l’admission à l’hôpital était de 2 [1–9] jours. La mortalité hospitalière était de 56,8 %, et un dispositif d’assistance ventriculaire a été implanté chez une importante proportion de patients (67,9 %). La mortalité à un an était de 61,7 %. Parmi les survivants hospitaliers, seuls 38,6 % ont reçu leur congé pour un retour indépendant à la maison. Le coût total médian [ÉIQ] pour l’année suivant l’admission parmi tous les patients était de 88 397 $ [32 718 – 225 628 $], dont 66 259 $ [22 789 – 183 165 $] étaient attribuables aux soins hospitaliers. CONCLUSION: La mortalité hospitalière parmi les patients en choc cardiogénique chez lesquels un Impella est installé est élevée, mais on n’observe qu’une augmentation minimale à un an. Alors que les patients ayant reçu un Impella ont engendré des coûts importants, ces coûts reflètent principalement les coûts hospitaliers et non les coûts encourus après le congé de l’hôpital.

Keywords: Impella; cardiogenic shock; health services; mechanical circulatory support.

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Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort study

Affiliations

Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort study

Authors

Affiliations

Abstract
in English, French

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous

Abstract in English, French

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Cited by

References

MeSH terms

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Abstract
in English, French