National Trends In The Utilization Of Short-term Mechanical Circulatory Support Devices During Ventricular Tachycardia Ablation Related Hospitalizations

Abstract

Background : Sparse data exists describing the characteristics of patients utilizing short term mechanical circulatory support (MCS) devices (intra-aortic balloon pumps, percutaneous ventricular assist devices, extracorporeal membrane oxygenation devices) during ventricular tachycardia (VT) ablation related hospitalizations. The purpose of this study was to characterize the demographics, in-hospital mortality, length of stay and hospital charges for MCS use. Methods : In this serial cross-sectional study, we analyzed all VT ablation related hospitalizations who received short-term MCS in the United States from 2010 to 2017 by using the Nationwide Readmission Database. Results : Among 384,742 hospitalizations with primary diagnosis of VT, 41,075 (10.7%) underwent ablation procedures (4,919 in 2010 to 5,349 in 2017). For those undergoing VT ablation procedures: mean age was 63.1 years, 22.5% were females, 56.9% Medicare insured, 31.0% private insured, 27.0% were elective admissions, unadjusted in-hospital mortality was 2.4%, mean length of stay was 6.6 days and mean hospitalization charge was $147,837. Among 41, 075 VT ablation hospitalizations, 2,479 (6.0%) required use of short term MCS and the utilization increased from 211 (4.3%) in 2010 to 364 (6.8%) in 2017, p<.05 (Figure 1). For these MCS requiring hospitalizations: mean age was 64.9 years, 9.7% were females, 67.1% Medicare insured, 22.1% private insured, 35.0% were elective admissions, unadjusted in-hospital mortality was 15.1%, mean length of stay was 12.9 days and mean hospitalization charge was $335,456. From 2010 to 2017, MCS group had following trends: mean age increased (63.4 years to 64.7 years), proportion of females decreased (14.7% to 6.6%), Medicare insured increased (64.9% to 69.0%), private insured decreased (28.6% to 22.9%) and proportion with elective admission status decreased (38.4% to 38.0%). From 2010 to 2017, unadjusted in-hospital mortality increased from 10.5% to 12.6% (p<.05), mean length of stay changed from 16.8 days to 11.2 days (p<0.05) and mean hospital charges increased from $251,637 to $386,952 (p<.05). Conclusions : Use of short-term MCS during VT ablation related hospitalizations in the United States increased rapidly and in-hospital mortality has remained high. Systematic and longitudinal collection of data in this high-risk group of patients is warranted to ensure improved outcomes in the future. : Sparse data exists describing the characteristics of patients utilizing short term mechanical circulatory support (MCS) devices (intra-aortic balloon pumps, percutaneous ventricular assist devices, extracorporeal membrane oxygenation devices) during ventricular tachycardia (VT) ablation related hospitalizations. The purpose of this study was to characterize the demographics, in-hospital mortality, length of stay and hospital charges for MCS use. : In this serial cross-sectional study, we analyzed all VT ablation related hospitalizations who received short-term MCS in the United States from 2010 to 2017 by using the Nationwide Readmission Database. : Among 384,742 hospitalizations with primary diagnosis of VT, 41,075 (10.7%) underwent ablation procedures (4,919 in 2010 to 5,349 in 2017). For those undergoing VT ablation procedures: mean age was 63.1 years, 22.5% were females, 56.9% Medicare insured, 31.0% private insured, 27.0% were elective admissions, unadjusted in-hospital mortality was 2.4%, mean length of stay was 6.6 days and mean hospitalization charge was $147,837. Among 41, 075 VT ablation hospitalizations, 2,479 (6.0%) required use of short term MCS and the utilization increased from 211 (4.3%) in 2010 to 364 (6.8%) in 2017, p<.05 (Figure 1). For these MCS requiring hospitalizations: mean age was 64.9 years, 9.7% were females, 67.1% Medicare insured, 22.1% private insured, 35.0% were elective admissions, unadjusted in-hospital mortality was 15.1%, mean length of stay was 12.9 days and mean hospitalization charge was $335,456. From 2010 to 2017, MCS group had following trends: mean age increased (63.4 years to 64.7 years), proportion of females decreased (14.7% to 6.6%), Medicare insured increased (64.9% to 69.0%), private insured decreased (28.6% to 22.9%) and proportion with elective admission status decreased (38.4% to 38.0%). From 2010 to 2017, unadjusted in-hospital mortality increased from 10.5% to 12.6% (p<.05), mean length of stay changed from 16.8 days to 11.2 days (p<0.05) and mean hospital charges increased from $251,637 to $386,952 (p<.05). : Use of short-term MCS during VT ablation related hospitalizations in the United States increased rapidly and in-hospital mortality has remained high. Systematic and longitudinal collection of data in this high-risk group of patients is warranted to ensure improved outcomes in the future.