343 - Recent Trends in Surgical Management of Heart Failure in the United States

Abstract

Background: Despite advances in medical management, patients with end stage heart failure (ESHF) have limited options which includes various surgical procedures. Objective: Our aim was to identify the trend of some of the surgical procedures undertaken for ESHF in the United States from 2008–2014 using Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database. Methods: We identified patients who were hospitalized with diagnosis of heart failure using appropriate International Classification of Diseases—9th edition (ICD-9) codes. We then identified patients undergoing heart transplantation (HT), left ventricular assist device (LVAD) placement, left ventricular aneurysmectomy (LVA), partial left ventriculectomy (pLV), artificial heart (AH) and Acorn CorCap (ACC) implantation using appropriate ICD-9 codes. We used linear-by-linear association to assess any changes in the trends of these surgical procedures. Results: We identified a total of 30,293,070 hospitalizations with heart failure from 2008 to 2014. A total of 14425 HT were performed in these years. There has been an 18% increase in number of HT (P < .001) with 1990 HT performed in 2008 compared to 2360 HT in 2014. A total of 18718 LVAD were performed from 2008 to 2014. LVAD showed a threefold increase (P < .001) with 1244 LVAD in 2008 which increased to 3790 in 2014. LVA showed a 40% decrease in trend (P < .001) with 656 LVA done in 2008 compared to 395 in 2014. pLV or Batista procedure was done in a total of 401 patients. It showed a 77% decrease in trend (P < .001) with 158 pLV done in 2008 compared to 35 in 2014. AH was implanted in 546 patients and it showed approximately 4-fold increase (P < .001) with 19 implantations in 2008 which increased to 75 in 2014. A total of 349 ACC were implanted and it showed an 80% decrease in trend (P < .001) with 78 ACC procedure in 2008 compared to 15 in 2014. Conclusion: From 2008 to 2014, LVAD showed a significant increase in trend while HT showed a modest rise. Although the increase in trend of AH was statistically significant, it is still under-utilized. LVA, pLV and ACC implantation showed a significant decline in trend and are now done only in few selected cases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)