Age Is a Predictor of In-Hospital Outcomes for Left Ventricular Assist Device Implantation: A Nationwide Analysis

Area of Science:

• Cardiology
• Transplant Surgery
• Health Services Research

Background:

• The 2018 heart allocation system reshaped heart transplantation and left ventricular assist device (LVAD) utilization.
• Understanding age-related outcomes after LVAD implantation is crucial in the current allocation era.

Purpose of the Study:

• To investigate age-specific in-hospital mortality and outcomes following LVAD implantation.
• To identify predictors of mortality in LVAD recipients in the post-allocation system era.

Main Methods:

• Analysis of 7375 patients undergoing LVAD implantation between 2019-2020 using the National Inpatient Sample.
• Stratification of patients into age groups: 18-49, 50-59, 60-69, and over 70.
• Primary endpoint: in-hospital mortality; secondary endpoints included length of stay, discharge disposition, and hospitalization cost.

Main Results:

• In-hospital mortality rates were significantly higher in older age groups: 12% for 60-69 and 17% for over 70, versus 6-7% for younger groups.
• Age groups 60-69 (aOR 1.99) and over 70 (aOR 2.88) were independent predictors of mortality.
• Higher Charlson Comorbidity Index (aOR 1.39) also predicted increased mortality; patients over 70 had shorter stays, and non-home discharge was high across all ages.

Conclusions:

• Patients aged 60 and above have an increased risk of in-hospital mortality after LVAD implantation in the post-2018 era.
• Age is a significant factor influencing LVAD outcomes, necessitating careful consideration in patient selection and management.
• Further research into optimizing care for older LVAD recipients is warranted.