320 - Recent Trends and Outcomes of LVAD Implantation in the ESRD Population: Analysis of 2010 - 2014 National Inpatient Sample Database

Abstract

Introduction: Left ventricular assist device (LVAD) utilization has consistently increased in recent years. It is unclear if this upward surge in LVAD utilization has benefited patients with end-stage renal disease (ESRD). Furthermore data on comparative outcomes in this population subset are scarce because these patients were excluded from major LVAD trials. Method: We used the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient database in the United States, to determine the recent trends of LVAD implantation in patients with ESRD. We also studied the trends, gender and racial disparities and in-hospital mortality associated with LVAD implantation in this high risk group. Results: Between 2010 and 2014, a total of 15,865 LVADs were implanted nationwide with a consistent increase across the years (2395 in 2010 to 3855 in 2014). 415 total LVAD implantations occurred in patients with ESRD, with a significant increase in implantation identified from 2010 (3.3%) compared to 2014 (5.2%, P trend < 0.05). Despite adjustment for heart failure (HF) admission rates, there was significant sex and racial disparities in LVAD utilization among ESRD patients, favoring men and Caucasians which has stayed consistent across the 5 year study period. Overall, high in-hospital mortality (54%) was observed in patients with ESRD who underwent LVAD implantation, however a trend showing decreased in hospital mortality was noted from 2010 to 2014 (69% to 48%, P trend < 0.05). Multivariable logistic regression analysis revealed pulmonary hypertension, age > 60 years and diabetes mellitus as independent predictors of in-hospital mortality in ESRD patients undergoing LVAD implantation. Conclusion: Our analysis confirms that 1) number of LVAD implants in the ESRD population have increased significantly between years 2010–2014; 2) There is significant gender and racial disparity in LVAD utilization among this comorbidity group, favoring men and Caucasians across all the 5 year study period; 3) In spite of high in-hospital mortality in this sub-group, there has been consistent decrease in the mortality from years 2010–2014; 4) Pulmonary hypertension, age > 60 years and diabetes mellitus are independent predictors of in-hospital mortality in ESRD patients undergoing LVAD implantation.