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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Long-term mortality and costs following use of Impella® for mechanical circulatory support: a population-based cohort
Shannon M Fernando1,2, Danial Qureshi3,4,5, Peter Tanuseputro3,4,5,6,7
1Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.
Insights
Mechanical circulatory support (MCS) with the Impella device shows high in-hospital mortality for cardiogenic shock patients. One-year survival rates are only slightly worse, with most costs tied to initial hospitalization.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- The Impella device is a critical mechanical circulatory support (MCS) option for adults with cardiogenic shock.
- Evaluating Impella's impact on patient outcomes and healthcare costs is essential for clinical and economic understanding.
Purpose of the Study:
- To assess short- and long-term outcomes, including mortality and healthcare utilization, following Impella device use in critically ill adults.
- To analyze the associated healthcare system costs in the year post-Impella insertion.
Main Methods:
- A retrospective, population-based cohort study of 162 adult patients (≥16 years) in Ontario, Canada, from April 2012 to March 2019.
- Data linkage with health administrative databases to track mortality (in-hospital, 30-day, 90-day, 1-year) and healthcare costs.
- Analysis of inpatient costs and costs incurred in the year following index admission.
Main Results:
- In-hospital mortality was 56.8%, with a 1-year mortality of 61.7%.
- A majority of patients (67.9%) were bridged to a ventricular assist device.
- Among survivors, only 38.6% were discharged home independently.
- Median total healthcare costs in the year post-admission were $88,397, with inpatient care comprising the majority.
Conclusions:
- In-hospital mortality for Impella use in cardiogenic shock is high, with only a marginal increase observed at one year.
- Substantial healthcare costs associated with Impella therapy are primarily driven by inpatient stays, not post-discharge utilization.
Purpose:
The Impella® device is a form of mechanical circulatory support (MCS) used in critically ill adults with cardiogenic shock. We sought to evaluate short- and long-term outcomes following the use of Impella, including mortality, healthcare utilization, and costs.
Methods:
Population-based, retrospective cohort study of adult patients (≥ 16 yr) receiving Impella in Ontario, Canada (1 April 2012-31March 2019). We captured outcomes through linkage to health administrative databases. The primary outcome was mortality during hospitalization. Secondary outcomes included mortality at 30 days, 90 days, and one year following Impella insertion. We analyzed health system costs in Canadian dollars in the year following the date of the index admission, including the costs of inpatient admission.
Results:
We included 162 patients. Mean (standard deviation) age was 59.2 (14.5) yr, and 73.5% of patients were male. Median [interquartile range (IQR)] time to Impella insertion from date of hospital admission was 2 [1-9] days. In-hospital mortality was 56.8%, and a significant proportion of patients were bridged to a ventricular assist device (67.9%). Mortality at one year was 61.7%. Among hospital survivors, only 38.6% were discharged home independently. Median [IQR] total cost in the year following admission among all patients was $88,397 [32,718-225,628], of which $66,529 [22,789-183,165] was attributed to inpatient care.
Conclusions:
In-hospital mortality among patients with cardiogenic shock receiving Impella is high, but with minimal increase at one year. While Impella patients accrued substantial costs, these largely reflected inpatient costs, and not costs incurred following hospital discharge.
