COST ANALYSIS OF INTRA-AORTIC BALLOON PUMP SUPORT DEVICE IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK

Abstract

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Intra-aortic balloon pumps (IABP) are the most commonly used mechanical support devices in patients with cardiogenic shock after a ST segment elevation myocardial infarction (STEMI) worldwide (1). Recently, the usage of IABP has been scrutinized after the IABP-SHOCK II trial in 2012 failed to demonstrate improvement in short or long term all-cause-mortality in patients treated with IABP versus medical therapy with STEMI and cardiogenic shock (CS). The European Society of Cardiology’s STEMI guidelines update in 2017 recommended against routine use of IABP in patients with STEMI and CS (3). Furthermore, ACCF/AHA STEMI guidelines have downgraded their level of recommendation from a Level I to a Level IIB recommendation. As cardiogenic shock contributes significantly to the economic health care burden with greater than a $2.7 billion in annual hospitalization cost, we conducted a cost analysis of IABPs versus medical therapy (vasopressors and inotropes) in this subpopulation. METHODS: A retrospective analysis was performed through chart review from January 2016 to September 2019. Using Premier Healthcare database, patient encounters with ICD 10 codes for cardiogenic shock, acute myocardial infarction and the procedural code for mechanical support device were selected. Each chart was individually reviewed and the presence of cardiogenic shock (defined as systolic blood pressure <90 and diastolic blood pressure <60) was confirmed in addition to STEMI and presence or absence of an IABP. The primary outcome measured was total hospital cost. RESULTS: The initial ICD 10 search yielded a total of 802 cases; after eliminating those that did not meet criteria, 91 in the IABP group and 50 in the medical therapy group remained. The average total cost of hospital stay per patient was higher in the IABP group than the medical therapy group; $52,271.44 vs $37,907 (p-value=.023). The observed/expected (O/E) cost was also higher in the IABP group with an O/E ratio of 1.54 vs 1.31. The medical therapy group appeared to have a greater severity of illness with an expected mortality of 48% versus 44% in the IABP group. The observed mortality was hence higher in the medical therapy group (48% versus 44% IABP). The two subgroups however had comparable O/E mortality ratios (2.38 medical therapy vs 2.31 IABP) suggesting similar outcomes when adjusting for severity of patient disease. CONCLUSIONS: Our data demonstrated an additional $14,364.44 in total hospital cost in patients treated with IABP versus medical therapy. The observed/expected mortalities were comparable in the two groups, consistent with prior studies suggesting no survival benefit with IABP utilization. CLINICAL IMPLICATIONS: Our study suggests that IABP may not be cost effective in comparison to medical therapy in patients with STEMI complicated by cardiogenic shock . DISCLOSURES: No relevant relationships by Lisa Ezegbu, source=Web Response No relevant relationships by Rhea Farquhar, source=Web Response no disclosure on file for Mitul Kanzaria; Speaker/Speaker's Bureau relationship with Abbvie Please note: $1001 - $5000 Added 06/14/2020 by Frances Loftus, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1-$1000 Added 06/14/2020 by Frances Loftus, source=Web Response, value=Honoraria No relevant relationships by Natalie Millet, source=Web Response No relevant relationships by URMIL PATEL, source=Web Response no disclosure on file for Giselle Raitz