Diffuse Connective Tissue Diseases and Left-Ventricular Assist Devices: Insights from the National Inpatient Sample

Abstract

Background Durable left-ventricular assist devices (LVAD) have become an increasingly frequent treatment strategy for end-stage heart failure (HF) but their use remains limited by complications including bleeding, thrombosis, and stroke. The impact of LVAD therapy on outcomes in HF patients with postulated higher risk comorbid conditions, such as diffuse connective tissue diseases (DCTD), has not been well studied to date. Given that these patients have an inherently higher risk of hematological complications than the general population, we aimed to investigate demographic characteristics and outcomes after LVAD implantation in this unique patient cohort. Methods Using the 2010-2014 Nationwide Inpatient Sample (NIS) database, we identified the overall demographic characteristics and the incidence of common LVAD complications in patients with DCTD. When possible, univariate logistic regression and t-test were used to compare baseline characteristics, specific outcomes and in-hospital mortality after LVAD implantation in patients with and without DCTD. Results A total of 50 patients (weighted) with DCTD were admitted for LVAD implantation from 2010-2014. Patients with DCTD were mostly female (70%), white (80%) and admitted electively for LVAD surgery (70%) ( Table 1 ). The most common disorder was systemic lupus erythematosus (60%), followed by polymyositis (20%), systemic sclerosis (20%), and combined syndromes (10%). During the index admission, there were no in-hospital deaths or stroke in DCTD patients undergoing LVAD. The risk of transfusion (50% vs 39.8%; p 0.514; OR 1.51), hemorrhage or hematoma complicating the procedure (30% vs 20.9%; p 0.486; OR 1.61), gastrointestinal bleeding (10% vs 8.5%; p 0.86; OR 1.2), or device-related complications such as pump thrombosis (10% vs 8.6%; p 0.873; OR 1.18), was not higher when compared to patients without DCTD ( Table 1 ). Conclusion To our knowledge, there is no published data with advanced HF therapies in patients with DCTD. The present analysis found that patients with DCTDs undergoing LVAD therapy do not appear to have a higher risk of bleeding, thrombotic events, stroke or in-hospital mortality after device implantation, but the majority of the DCTD patients in this cohort underwent elective LVAD surgery. As LVADs become increasingly utilized in the advanced HF population, including those with systemic conditions that disqualify them for transplantation, further research is needed to identify additional adverse factors and comorbidities that could significantly impact post-LVAD outcomes.