PDF(Pubmed)
Abstract：
UNASSIGNED: Trends in temporary mechanical circulatory support (tMCS) use with associated outcomes and cost in cardiogenic shock secondary to decompensated chronic heart failure (HF-CS) remains poorly understood. We describe trends in tMCS use, associated outcomes, and cost in HF-CS.
UNASSIGNED: We included adults enrolled in a national insurance claims dataset with HF-CS who received intra-aortic balloon pump (IABP), Impella, or extracorporeal membrane oxygenation (ECMO) without acute coronary syndrome, or postcardiotomy shock. We identified predictors of device use, associated outcomes, and inflation-adjusted costs.
UNASSIGNED: We studied 2722 HF-CS patients receiving tMCS: 1799 (66%) male, 1771 (65%) White, and 1836 (67%) with ischemic cardiomyopathy. Rate of tMCS use increased from 2010-2019. Impella use showed the largest increase (Δ+344%), followed by ECMO (Δ+112%). Patients receiving ECMO had a higher comorbidity burden, and patients receiving IABP were more likely to have valvular heart disease. Compared with IABP, 30-day mortality rate was no different for Impella (adjusted odds ratio, 1.24; 95% CI, 0.93-1.66) but was higher with ECMO (adjusted odds ratio, 3.08; 95% CI, 2.22-4.27). Adjusted hospitalization cost was highest for ECMO (median, $191,079 [IQR, $165,760-$239,373]), followed by Impella (median, $142,518 [IQR, $126,845-$179,938]), and IABP (median, $132,060 [IQR, $113,794-$160,244]). We observed a linear association between price standardized cost-quartile and complications, but not for 30-day mortality.
UNASSIGNED: The use of Impella and ECMO is increasing with an associated cost increase. The use of ECMO coincided with higher 30-day mortality compared with IABP in HF-CS. These findings likely reflect increasing disease severity and evolving practice patterns rather than causation.
UNASSIGNED: We included adults enrolled in a national insurance claims dataset with HF-CS who received intra-aortic balloon pump (IABP), Impella, or extracorporeal membrane oxygenation (ECMO) without acute coronary syndrome, or postcardiotomy shock. We identified predictors of device use, associated outcomes, and inflation-adjusted costs.
UNASSIGNED: We studied 2722 HF-CS patients receiving tMCS: 1799 (66%) male, 1771 (65%) White, and 1836 (67%) with ischemic cardiomyopathy. Rate of tMCS use increased from 2010-2019. Impella use showed the largest increase (Δ+344%), followed by ECMO (Δ+112%). Patients receiving ECMO had a higher comorbidity burden, and patients receiving IABP were more likely to have valvular heart disease. Compared with IABP, 30-day mortality rate was no different for Impella (adjusted odds ratio, 1.24; 95% CI, 0.93-1.66) but was higher with ECMO (adjusted odds ratio, 3.08; 95% CI, 2.22-4.27). Adjusted hospitalization cost was highest for ECMO (median, $191,079 [IQR, $165,760-$239,373]), followed by Impella (median, $142,518 [IQR, $126,845-$179,938]), and IABP (median, $132,060 [IQR, $113,794-$160,244]). We observed a linear association between price standardized cost-quartile and complications, but not for 30-day mortality.
UNASSIGNED: The use of Impella and ECMO is increasing with an associated cost increase. The use of ECMO coincided with higher 30-day mortality compared with IABP in HF-CS. These findings likely reflect increasing disease severity and evolving practice patterns rather than causation.
摘要：
■暂时机械循环支持(tMCS)使用与失代偿性慢性心力衰竭(HF-CS)继发心源性休克相关结局和成本的趋势仍知之甚少。我们描述了tMCS使用的趋势，相关结果，和成本在HF-CS。
■我们包括了在国家保险索赔数据集中注册的使用HF-CS的成年人，他们接受了主动脉内球囊泵（IABP），Impella,或无急性冠状动脉综合征的体外膜氧合（ECMO），或心脏切开术后休克。我们确定了设备使用的预测因素，相关结果，和通货膨胀调整后的成本。
■我们研究了2722例接受tMCS的HF-CS患者：1799（66％）男性，1771（65%）白色，和1836（67%）缺血性心肌病。2010-2019年tMCS使用率上升。Impella使用显示最大的增加(Δ+344%)，其次是ECMO(Δ+112%)。接受ECMO的患者有较高的共病负担，接受IABP的患者更有可能患有心脏瓣膜病.与IABP相比,Impella的30天死亡率没有差异(调整后的优势比，1.24；95%CI，0.93-1.66)，但ECMO较高(调整后的比值比，3.08；95%CI，2.22-4.27）。ECMO的调整后住院费用最高(中位数，$191,079[IQR,$165,760-$239,373])，其次是Impella(中位数，$142,518[IQR，$126,845-$179,938])，和IABP（中位数，$132,060[IQR,$113,794-$160,244]）。我们观察到价格标准化的成本四分位数与并发症之间存在线性关系，但不是30天的死亡率。
■Impella和ECMO的使用随着相关成本的增加而增加。在HF-CS中，与IABP相比，使用ECMO的30天死亡率更高。这些发现可能反映了疾病严重程度的增加和实践模式的演变，而不是因果关系。
■我们包括了在国家保险索赔数据集中注册的使用HF-CS的成年人，他们接受了主动脉内球囊泵（IABP），Impella,或无急性冠状动脉综合征的体外膜氧合（ECMO），或心脏切开术后休克。我们确定了设备使用的预测因素，相关结果，和通货膨胀调整后的成本。
■我们研究了2722例接受tMCS的HF-CS患者：1799（66％）男性，1771（65%）白色，和1836（67%）缺血性心肌病。2010-2019年tMCS使用率上升。Impella使用显示最大的增加(Δ+344%)，其次是ECMO(Δ+112%)。接受ECMO的患者有较高的共病负担，接受IABP的患者更有可能患有心脏瓣膜病.与IABP相比,Impella的30天死亡率没有差异(调整后的优势比，1.24；95%CI，0.93-1.66)，但ECMO较高(调整后的比值比，3.08；95%CI，2.22-4.27）。ECMO的调整后住院费用最高(中位数，$191,079[IQR,$165,760-$239,373])，其次是Impella(中位数，$142,518[IQR，$126,845-$179,938])，和IABP（中位数，$132,060[IQR,$113,794-$160,244]）。我们观察到价格标准化的成本四分位数与并发症之间存在线性关系，但不是30天的死亡率。
■Impella和ECMO的使用随着相关成本的增加而增加。在HF-CS中，与IABP相比，使用ECMO的30天死亡率更高。这些发现可能反映了疾病严重程度的增加和实践模式的演变，而不是因果关系。
