Outcomes of Hospitalizations for Cardiogenic Shock at Left Ventricular Assist Device Versus Non-Left Ventricular Assist Device Centers

Abstract

Background Cardiogenic shock (CS) is a complex syndrome associated with high morbidity and mortality. In recent years, many US hospitals have formed multidisciplinary shock teams capable of rapid diagnosis and triage. Because of preexisting collaborative systems of care, hospitals with left ventricular assist device (LVAD) programs may also represent "centers of excellence" for CS care. However, the outcomes of patients with CS at LVAD centers have not been previously evaluated. Methods and Results Patients with CS were identified in the 2012 to 2014 National Inpatient Sample. Clinical characteristics, revascularization rates, and use of mechanical circulatory support were analyzed in LVAD versus non-LVAD centers. The association between hospital type and in-hospital mortality was examined using multivariable logistic regression models. Of 272 075 hospitalizations, 26.0% were in LVAD centers. CS attributable to causes other than acute myocardial infarction represented most cases. In-hospital mortality was lower in LVAD centers (38.9% versus 43.3%; P<0.001). In multivariable analysis, the odds of mortality remained significantly lower for hospitalizations in LVAD centers (odds ratio, 0.89; P<0.001). In patients with CS secondary to acute myocardial infarction, revascularization rates were similar between LVAD and non-LVAD centers. The use of intra-aortic balloon pump (18.7% versus 18.8%) and Impella/TandemHeart (2.6% versus 1.9%) was similar between hospital types, whereas extracorporeal membrane oxygenation was used more frequently in LVAD centers (4.3% versus 0.2%; P<0.001). Conclusions Risk-adjusted mortality was lower in patients with CS who were hospitalized at LVAD centers. These centers likely represent specialized, shock team capable institutions across the country that may be best suited to manage patients with CS.

Keywords: cardiogenic shock; left ventricular assist device; mechanical circulatory support.

Figure 1. Study population.

Flowchart of study patients. LVAD indicates left ventricular assist device; and NIS, National Inpatient Sample.

Figure 2. Temporary mechanical support in left ventricular assist device (LVAD) vs non‐LVAD centers, subdivided into the cardiogenic shock after acute myocardial infarction (AMI‐CS) and cardiogenic shock related to causes other than acute myocardial infarction (non–AMI‐CS) subpopulations.

ECMO indicates extracorporeal membrane oxygenation; IABP, intra‐aortic balloon pump; and LVAD, left ventricular assist device.

Figure 3. Association between left ventricular assist device (LVAD) centers vs non‐LVAD centers and in‐hospital mortality in cardiogenic shock.

AMI indicates acute myocardial infarction; CABG, coronary artery bypass grafting; OR, odds ratio; and PCI, percutaneous coronary intervention.