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Utilization of Implantable Cardioverter Defibrillators Among Patients with a Left Ventricular Assist Device: Insights
Muhammad Shariq Usman1, Abdul Mannan Khan Minhas2, Stephen J Greene3
1Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
Insights
The implantation rate of implantable cardioverter defibrillators (ICDs) with left ventricular assist devices (LVADs) decreased significantly from 2009-2018. Concurrent ICD-LVAD implantation was linked to lower mortality but longer hospital stays and higher costs.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- Implantable cardioverter defibrillator (ICD) use in patients with left ventricular assist devices (LVADs) is not well-defined.
- Understanding trends and outcomes of concurrent ICD and LVAD implantation is crucial for patient management.
Purpose of the Study:
- To analyze trends in ICD implantation concurrent with LVAD procedures.
- To identify factors associated with concurrent ICD implantation.
- To evaluate the impact of concurrent ICD implantation on hospital outcomes.
Main Methods:
- Retrospective analysis of the National Inpatient Sample (2009-2018).
- Identification of hospitalizations involving new or replacement LVADs and ICD implantations using procedure codes.
- Statistical analysis to determine trends, associated factors, and outcomes.
Main Results:
- The rate of ICD implantation during LVAD procedures declined annually by 23.2% (P < 0.001).
- Younger age, White race, and in-hospital cardiac arrest were associated with concurrent ICD implantation.
- Concurrent ICD implantation correlated with longer hospital stays, higher costs, and reduced in-hospital mortality (aOR=0.29).
Conclusions:
- The use of ICDs concurrently with LVAD implantation has decreased significantly.
- While associated with improved survival, concurrent ICD implantation increases hospital resource utilization.
- Further research may be needed to optimize device selection and patient selection criteria.
Abstract:
The trends of implantable cardioverter defibrillator (ICD) use in patients with a durable left ventricular assist device (LVAD) remain uncertain. We used the National Inpatient Sample to identify hospitalizations between 2009 and 2018 in which patients received a new LVAD or had a pre-existing one. Procedure codes were then used to identify hospitalizations in which a new ICD was implanted. In 34,113 hospitalizations for new and/or replacement LVADs, an ICD was implanted in 1297 (3.8%). The rate of ICD implantation along with an LVAD declined from 2009 to 2018 (annual percent change: -23.2%; P-trend < 0.001). Independent factors associated with concurrent ICD implantation in patients receiving LVAD were younger age, White (compared with Black) race, and in-hospital cardiac arrest. Concurrent ICD implantation was associated with a longer hospital stay (adjusted mean difference: 4.48 days) and higher inflation-adjusted costs (adjusted mean difference: $31,679), but lower in-hospital mortality rates (adjusted odds ratio: 0.29; P < 0.001), compared with LVAD placement alone. Amongst 95,583 hospitalizations of patients with a pre-existing LVAD, an ICD was placed in 616 (0.64%). There was no change in the rate of ICD implantation from 2009 to 2018 in patients with a pre-existing LVAD (annual percent change: -10.34%; P = 0.18).
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